Chapter 207 Differential diagnosis of Crohn’s disease and intestinal tuberculosis

“PPD test – strong positive!”

Zhou Mo: “…”

Feeling bewildered.

He only tested for intestinal tuberculosis empirically, but he didn’t actually suspect intestinal tuberculosis too much.

did not expect,

It turned out to be intestinal tuberculosis!

And it’s still strong positive.

After the human body has been infected with tuberculosis for a period of time, the tuberculin can show a positive reaction. The results are judged as follows: within 24-72 hours after the injection of PPD, the skin induration within 5mm of the straight meridian is negative, 5-9mm is weakly positive, 10-19mm is positive, more than 20mm or less than 20mm but blisters and necrosis appear. Strong positive.

A strong positive indicates a more severe infection.

In addition to strong positives, there are also weak positives, which are test results between positives and negatives. Sometimes they are meaningful, and sometimes a weakly positive test diagnosis may be given because the judgment of the testing doctor or the testing machine is not clear. . But most weak positives are relatively clear cases.

……

Back to the patient Fang Xiaozhong,

Zhou Mo faced two directions.

1. Crohn’s disease.

2. Intestinal tuberculosis.

Both are possible.

The first case: If the diagnosis of Crohn’s disease is used as the treatment plan, the most critical drugs are: mesalazine, hormones, and azathioprine.

But there is a problem with this. Tuberculosis cannot use hormones, because hormones stimulate tuberculosis and make the disease progress rapidly.

The second situation: If the diagnosis of intestinal tuberculosis is used to carry out the treatment plan, another problem will arise. The treatment of intestinal tuberculosis will be very slow and a long-term process. If the patient has Crohn’s disease, then it’s all over the place.

Therefore, if you have been vaccinated with BCG, you may have strong positive results. Another point is that if it is Crohn’s disease, it means that the patient’s immune system is disordered, and it is normal to have a strong positive. )

so,

Zhou Mo was in a dilemma.

The only way is to further diagnose whether it is intestinal tuberculosis or Crohn’s disease.

Zhou Mo further inquired: “Have you ever had a cough or something?”

Because intestinal tuberculosis is contagious, it will go to the lungs and become pulmonary tuberculosis and liver tuberculosis, and pulmonary tuberculosis will have symptoms such as coughing.

The patient Fang Xiaozhong shook his head on the spot: “No.”

Zhou Mo: “Open your mouth and show me.”

Crohn’s disease is characterized by ulcers in the mouth.

“Ah~~~”

Fang Xiaozhong opened his mouth,

Zhou Mo took a flashlight and looked at it.

Look carefully,

The patient Fang Xiaozhong’s mouth has no symptoms of ulcers.

In addition, it is also poor whether the patient has abdominal mass, clubbing, skin damage, etc…

The final result is: none! !

Zhou Mo was disappointed,

At present, neither side has found supporting evidence for the time being.

It seems that further inspection is required.

First of all, for intestinal tuberculosis, use another test method

——Interferon release test from T cells infected with tuberculosis

The principle is similar to the PPD test, and the accuracy is higher.

Unaffected by BCG vaccination and environmental mycobacteria.

After our body is infected with Mycobacterium tuberculosis, some memory cells will be produced. When the antigen is encountered again, the memory cells will respond. The inspection principle is roughly the same.

But it still has shortcomings: its positive can only indicate that the body has had tuberculosis before, and cannot distinguish whether it is currently active tuberculosis or not.

but,

This inspection is still to be done.

In addition, you can leave sputum and send it for examination to find out if there is tuberculosis.

“Doctor, what’s the problem with me now?”

Fang Xiaozhong saw Zhou Mo because he saw something, so he couldn’t help asking.

“It’s not confirmed yet, we need to continue to check.”

“Ah? Not yet?”

“Okay, there is still some time now. Let me tell you, I have two diagnoses of your condition, one is Crohn’s disease and the other is intestinal tuberculosis.”

Then I briefly introduced it.

After I introduced it to the patient, I made a will and did an interferon release test.

……

Zhou Mo returned to the duty room.

While calling the infectious disease department, the department consulted.

Because intestinal tuberculosis is a category of infectious diseases, it is best to consult the infectious diseases department and ask the infectious diseases department to make a doctor’s order.

Also, call and ask Teacher Zhang Luojia to see what to do in this situation.

Crohn’s disease, intestinal tuberculosis, and an ulcerative colitis are relatively similar diseases, especially Crohn’s disease and intestinal tuberculosis, which are often mistaken for each other.

soon,

Zhang Luojia gave Zhou Mo a very mature plan——

——Use a non-hormonal regimen to treat Crohn’s disease, and then watch the patient’s disease progress. If it works, it proves to be Crohn’s disease. Invalid, it proves intestinal tuberculosis.

At present, in major hospitals across the country, biological agents are used more and more for the treatment of ulcerative bowel disease.

It can be used for patients with moderate to severe active Crohn’s disease who have not received traditional treatment. It can reduce symptoms and signs, and achieve and maintain clinical efficacy.

However, it also has many side effects.

Skin, nerves, cardiovascular, muscles, defense systems, etc., are all likely to be affected.

However, in the case that the tuberculosis cannot be determined, it can be used to test, and the dosage can be controlled to minimize side effects.

At this moment,

“Dr. Zhou Mo, the consultation doctor of the infectious disease department is here.”

“OK.”

Zhou Mo walked out of the duty room quickly, he already had some confidence in treating patients.

The doctor from the Department of Infectious Diseases is Zhou Meiling, a female doctor who is the attending physician.

“Yo, it’s you, handsome boy.”

“This teacher is good.”

“Call me Teacher Zhou, I have the same last name as you.”

Zhou Mo brought Dr. Zhou to Fang Xiaozhong’s bed.

Zhou Mo introduced it.

“Intestinal tuberculosis? Crohn’s disease? It’s simple. Just follow the Crohn’s disease test and treat it first. If there is a result, it means Crohn’s disease. If there is no result, it proves to be intestinal tuberculosis…”

Zhou Mo listened.

Sure enough,

The doctor’s plan of the infectious disease department also works! ! !

At last,

Zhou Mo invited Mr. Zhang Luojia over the phone to discuss with Dr. Zhou from the Department of Infectious Diseases.

In the end, the plan was rejected.

That’s right,

No dropped.

Because there are too many side effects of gram therapy, try not to use this method until the last minute. At least eliminate this distraction.

.