Scholarlink

Background <p>This case report addresses the diagnostic challenge of distinguishing intestinal tuberculosis (ITB) from Crohn’s disease, with a focus on the potential role of fecal zonulin as a noninvasive biomarker.</p> Case presentation <p>A 43-year-old female with a history of deep vein thrombosis, asthma, and previously treated pulmonary tuberculosis presented with fatigue, chronic diarrhea, diffuse abdominal pain, significant weight loss (~ 20&#xa0;kg), and anorexia. Laboratory findings included a positive fecal occult blood test and markedly elevated fecal calprotectin (3370&#xa0;µg/g, normal range: &lt; 50&#xa0;μg/g). Celiac disease serologies were negative. Abdominopelvic tomography showed pathological thickening of the digestive tract wall. Fecal zonulin was normal (10.75&#xa0;ng/mL, reference range &lt; 107&#xa0;ng/mL). Upper endoscopy revealed multiple gastric ulcers and an esophageal ulcer suggestive of tuberculosis. Despite clinical and biochemical features mimicking IBD, endoscopic findings and normal fecal zonulin levels prompted suspicion of gastrointestinal TB. The pulmonology department confirmed intestinal tuberculosis and reactivation of the pulmonary tuberculosis after microscopic examination of the patient’s sputum and fecal samples. Antituberculous therapy was initiated with favorable evolution.</p> Conclusion <p>This case highlights the diagnostic overlap between ITB and Crohn’s disease and underlines the importance of integrating clinical history, imaging, and biomarkers. Fecal zonulin may aid in differentiating ITB from Crohn’s disease by reflecting intestinal permeability patterns, potentially preventing misdiagnosis and inappropriate immunosuppressive treatment. As a biomarker reflecting intestinal barrier integrity, fecal zonulin measurement may have broader implications that warrant further investigation.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Fecal zonulin in the differential diagnosis of intestinal tuberculosis and Crohn’s disease: a case report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月30日

查看全文
  • Sergiu Ioan Frandes,
  • Melania Macarie,
  • Andreea Gligor,
  • Oana Frandes,
  • Emmanuel Becica,
  • Simona Maria Bataga

摘要

Background

This case report addresses the diagnostic challenge of distinguishing intestinal tuberculosis (ITB) from Crohn’s disease, with a focus on the potential role of fecal zonulin as a noninvasive biomarker.

Case presentation

A 43-year-old female with a history of deep vein thrombosis, asthma, and previously treated pulmonary tuberculosis presented with fatigue, chronic diarrhea, diffuse abdominal pain, significant weight loss (~ 20 kg), and anorexia. Laboratory findings included a positive fecal occult blood test and markedly elevated fecal calprotectin (3370 µg/g, normal range: < 50 μg/g). Celiac disease serologies were negative. Abdominopelvic tomography showed pathological thickening of the digestive tract wall. Fecal zonulin was normal (10.75 ng/mL, reference range < 107 ng/mL). Upper endoscopy revealed multiple gastric ulcers and an esophageal ulcer suggestive of tuberculosis. Despite clinical and biochemical features mimicking IBD, endoscopic findings and normal fecal zonulin levels prompted suspicion of gastrointestinal TB. The pulmonology department confirmed intestinal tuberculosis and reactivation of the pulmonary tuberculosis after microscopic examination of the patient’s sputum and fecal samples. Antituberculous therapy was initiated with favorable evolution.

Conclusion

This case highlights the diagnostic overlap between ITB and Crohn’s disease and underlines the importance of integrating clinical history, imaging, and biomarkers. Fecal zonulin may aid in differentiating ITB from Crohn’s disease by reflecting intestinal permeability patterns, potentially preventing misdiagnosis and inappropriate immunosuppressive treatment. As a biomarker reflecting intestinal barrier integrity, fecal zonulin measurement may have broader implications that warrant further investigation.