4,8 Clinically, both can be present in an insidious manner with chronic abdominal and systemic symptoms.10 However, a previous or family history of TB, history of chronic immunosuppression, and an origin from a country of high TB endemicity are all suggestive of TB rather than Crohn’s disease. Fistulizing disease is one of the hallmarks of Crohn’s disease but this is also well described in intestinal TB.10 Histologically, both Crohn’s disease and intestinal TB are characterized by granulomatous inflammation but multiple large confluent caseating granulomas which may be submucosal and associated with disproportionate submucosal inflammation, caseous necrosis, and ulcers lined with epithelioid histiocytes are

more commonly seen in intestinal TB.10,12–14

Once a definitive or presumptive diagnosis has been made of TB, treatment with standard regime antituberculous MDV3100 price drugs is highly effective.4 Our case illustrates the importance of considering intestinal TB as a significant differential to Crohn’s disease, especially in patients with high-risk demographics. The overlapping clinical features and lack of rapid and specific diagnostic tests highlight the diagnostic challenge posed by intestinal TB. The current TB incidence in Nepal is 163/100,000 which contrasts markedly to Australia’s 6.4/100,00015 highlighting the burden of disease that is transferable with the advent of rising migration from countries of high TB endemicity. It is therefore more ABT-199 clinical trial likely that local clinicians will face the diagnostic

dilemma of differentiating intestinal TB from PJ34 HCl Crohn’s disease. The importance of this is further emphasized by the significant differences in treatment of the two diseases and the potentially dire consequences that may ensue in misdiagnosing intestinal TB for Crohn’s disease. The authors state they have no conflicts of interest to declare. “
“Diagnostic confusion may occur between dengue and malaria when febrile patients with thrombocytopenia return from travel to previous malaria endemic areas. Laboratory tests should include blood smear examination for malaria parasites even though current malaria endemicity in Sri Lanka is low. Sri Lanka has been able to significantly reduce its malaria burden since the year 2000. The overall reduction in the reported positives is 99%.1 In contrast there has been an exponential increase in the incidence of dengue fever since 2004.2,3 In the wake of this epidemic, during the year 2010, the number of dengue infections reported in the country was 34,105 while the malaria incidence has remained low at 703 (of which 52 cases were imported malaria originating in other countries).4,5 In addition to the similar clinical expression of the two diseases there is also an overlap of the dengue and malaria endemic regions in the country with malaria–dengue coinfections being reported during the past 2 years.