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How can intestinal tuberculosis be treated?

Q: My 30 years old wife is suffering from severe pain in her abdomen for the last 3 months. She got ultrasound, barium test, TST elisa test and HIV test done for the same. The ultrasound report states a marked thickening of bowel in the RIF with multiple enlarged lymph nodes ranging from 11.5 to 13.3 but no ascites. The barium test reveals a stricture in the terminal ileum and contracture of the caecum. TST result is positive and TB IgG was 765 and TB IgM was 1.7 sero units. Do these results indicate intestinal tuberculosis? The doctor has prescribed anti-TB chemotherapy drugs - Rifampicin, Ethambutol, Isoniazid and Levofloxacin, Folinal plus. I have come to know that these drugs have severe side effects. Are these drugs safe? The doctor also referred my wife to a surgeon for further investigation. I read somewhere that intestinal TB and Crohn’s disease symptoms are similar. Is it intestinal TB or crohn’s diseaseIs it safe for her to get pregnant now?

A:It has always been a medical diagnostic dilemma between Crohns disease and intestinal TB, as Crohns disease mostly affects the small intestines. If there is evidence of TB infection she should complete the course of treatment for the infection and also surgical opinion for strictureplasty by a surgeon. Before that if the stricture is in the lower part of the small bowel, i.e., the terminal ileum, it should be possible to get terminal ileal biopsies through a colonoscope if carried out by an expert. This should give an answer but sometimes the histological diagnosis between the two conditions may not be clear cut and the biopsy would need culturing to grow TB bacteria for an answer. Srictureplasty will relieve the mechanical bowel narrowing and thus prevent the possibility of obstruction. You should wait for having a family till after her treatment.


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