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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dear Editor</span>&#44;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The distinction between Crohn&#39;s disease and intestinal tuberculosis is a diagnostic challenge as they present similar clinical&#44; radiological&#44; endoscopic and histological features&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> A definitive diagnosis in these cases is extremely important&#44; to avoid the toxicity of unnecessary anti-tuberculous therapy in patients with Crohn&#39;s disease and potentially fatal immunosuppressive treatment in patients with intestinal TB&#46; Histological examination&#44; complemented by other diagnostic tests&#44; including tests of nucleic acid amplification&#44; is pivotal in the differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Other methods like immunohistochemistry are emerging with promising results in determining early differentiation of both illnesses&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with Crohn&#39;s disease eligible for TNF antagonist &#40;infliximab or adalimumab&#41; or other immunosuppressive treatment are frequently sent to our Pneumologic Diagnosis Center for TB screening&#44; as recommended by TBNET consensus statement&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The screening program includes a symptom questionnaire&#44; a tuberculin skin test &#40;PPD RT23&#41;&#44; interferon gamma release assay &#40;IGRA&#41; and chest radiography&#46; The need for a solid diagnosis&#44; before qualifying patients for TNF antagonists&#44; led us to include in the screening programme a revision of biopsy specimens with acid fast bacilli smear&#44; nucleic acid amplification test and cultural examination in recent biopsies or&#44; at least&#44; to ensure that these had previously been performed&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We therefore decided to carry out a retrospective cohort from 2008 to analyze how this measure has helped to exclude intestinal tuberculosis and safely qualify patients for anti-TNF treatment&#46; We included 47 patients with the diagnosis of Crohn&#39;s disease&#59; 51&#37; female and mean age of 38 years old&#46; Revision of endoscopic biopsies was possible in 25 &#40;53&#37;&#41; individuals&#46; Two &#40;8&#37;&#41; cases of intestinal TB were diagnosed by this process&#44; one with positive smear&#44; other with both positive nucleic acid amplification test and culture&#46; Both started anti-TB treatment&#46; Patients eligible for immunosuppressive therapy had three different outcomes&#58; 21 patients had TB latent infection and were submitted to 9-month isoniazid regimen&#59; in 2 patients Crohn&#39;s disease was replaced by intestinal TB as a correct diagnosis&#59; 24 patients had negative TB screening and qualified to for anti-TNF treatment&#46; Twenty-seven patients started anti-TNF therapy &#40;the 24 patients that had negative TB screening and 3 patients under TB latent infection treatment&#41; and none developed active TB&#46; In summary&#44; this procedure allowed us to diagnose 2 cases of intestinal tuberculosis misinterpreted as Crohn&#39;s disease and to safely initiate TNF antagonist without any case of active TB following that treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; investigation of patients with suspected Crohn&#39;s disease should always include differential diagnosis with intestinal tuberculosis&#46; Acid fast bacilli smear&#44; nucleic acid amplification tests and culture are warranted in pathological examination of endoscopic biopsies&#46; These procedures are currently routine practice in our Pneumologic Diagnosis Center&#44; when investigating patients with suspected Crohn&#39;s disease&#46; Alternative routes of differentiating both illnesses have been mentioned by others<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and may be added to the screening program in the future&#46;</p></span>"
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Letter to the Editor
Crohn's disease and intestinal tuberculosis: A clinical challenge
Doença de Crohn e tuberculose intestinal: um desafio clínico
R. Roloa,b,
Corresponding author
rui.rolo@sapo.pt

Corresponding author.
, S. Campainhaa,d, R. Duartea,b,c,e
a Centro de Diagnóstico Pneumológico de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
b Serviço de Pneumologia, Hospital de Braga, Braga, Portugal
c Centro de Referência Regional de TBMR do Norte, Portugal
d Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
e Departamento de Epidemiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dear Editor</span>&#44;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The distinction between Crohn&#39;s disease and intestinal tuberculosis is a diagnostic challenge as they present similar clinical&#44; radiological&#44; endoscopic and histological features&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> A definitive diagnosis in these cases is extremely important&#44; to avoid the toxicity of unnecessary anti-tuberculous therapy in patients with Crohn&#39;s disease and potentially fatal immunosuppressive treatment in patients with intestinal TB&#46; Histological examination&#44; complemented by other diagnostic tests&#44; including tests of nucleic acid amplification&#44; is pivotal in the differential diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Other methods like immunohistochemistry are emerging with promising results in determining early differentiation of both illnesses&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with Crohn&#39;s disease eligible for TNF antagonist &#40;infliximab or adalimumab&#41; or other immunosuppressive treatment are frequently sent to our Pneumologic Diagnosis Center for TB screening&#44; as recommended by TBNET consensus statement&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The screening program includes a symptom questionnaire&#44; a tuberculin skin test &#40;PPD RT23&#41;&#44; interferon gamma release assay &#40;IGRA&#41; and chest radiography&#46; The need for a solid diagnosis&#44; before qualifying patients for TNF antagonists&#44; led us to include in the screening programme a revision of biopsy specimens with acid fast bacilli smear&#44; nucleic acid amplification test and cultural examination in recent biopsies or&#44; at least&#44; to ensure that these had previously been performed&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We therefore decided to carry out a retrospective cohort from 2008 to analyze how this measure has helped to exclude intestinal tuberculosis and safely qualify patients for anti-TNF treatment&#46; We included 47 patients with the diagnosis of Crohn&#39;s disease&#59; 51&#37; female and mean age of 38 years old&#46; Revision of endoscopic biopsies was possible in 25 &#40;53&#37;&#41; individuals&#46; Two &#40;8&#37;&#41; cases of intestinal TB were diagnosed by this process&#44; one with positive smear&#44; other with both positive nucleic acid amplification test and culture&#46; Both started anti-TB treatment&#46; Patients eligible for immunosuppressive therapy had three different outcomes&#58; 21 patients had TB latent infection and were submitted to 9-month isoniazid regimen&#59; in 2 patients Crohn&#39;s disease was replaced by intestinal TB as a correct diagnosis&#59; 24 patients had negative TB screening and qualified to for anti-TNF treatment&#46; Twenty-seven patients started anti-TNF therapy &#40;the 24 patients that had negative TB screening and 3 patients under TB latent infection treatment&#41; and none developed active TB&#46; In summary&#44; this procedure allowed us to diagnose 2 cases of intestinal tuberculosis misinterpreted as Crohn&#39;s disease and to safely initiate TNF antagonist without any case of active TB following that treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; investigation of patients with suspected Crohn&#39;s disease should always include differential diagnosis with intestinal tuberculosis&#46; Acid fast bacilli smear&#44; nucleic acid amplification tests and culture are warranted in pathological examination of endoscopic biopsies&#46; These procedures are currently routine practice in our Pneumologic Diagnosis Center&#44; when investigating patients with suspected Crohn&#39;s disease&#46; Alternative routes of differentiating both illnesses have been mentioned by others<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and may be added to the screening program in the future&#46;</p></span>"
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Article information
ISSN: 21735115
Original language: English
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