I probably need to stay off the computer and stop worrying myself sick. I was just curious if Intestinal TB is often misdiagnosed as MC? I have been losing weight, steatorrhea diarrhea and some night sweats. Would a colonoscopy or small pill camera rule out intestinal TB? Perhaps, I'm petrified of infections since my encounter with C.Diff in May.
My GI at UF Shands has been on vacation, so I've had no luck getting in contact with her for a treatment plan. I can't continue on the path of weight loss and steatorrhea. I'm suffering. I have LC & celiac and I've been GF for over 2 years.
Here's my most recent colonoscopy/pathology:
Terminal ileum appeared normal. All parts of colon had mildly congested mucosa.
Terminal ileum biopsy:
Histologic sections show mild intraepithelial lymphocytosis, including villous tips, with preservation of the villous architecture. This finding is likely related to this patients lymphocytic colitis. Nevertheless, similar findings have been described in a wide variety of conditions, particularly treated or latent celiac sprue and non-steroidal anti-inflammatory drug use. Correlation with clinical and/or laboratory findings, including antigluten serology, may be useful to distinguish between these other possible causes. An immunohistochemical stain for mast cell tryptase demonstrates a mast cell number that is within normal limits.
Ascending colon biopsy:
-Lymphocytic colitis. See comment.
Sigmoid colon biopsy:
-Lymphocytic colitis. See comment.
Rectum biopsy:
-Lymphocytic colitis. See comment.
Comment: The findings are in keeping with the patient's reported history of lymphocytic colitis. There is intraepithelial lymphocytosis within crypts and surface epithelium, surface epithelial degeneration, and an increased lamina propria lymphoplasmacytic infiltrate. There is no evidence of collagenous colitis. While these findings are characteristic of lymphocytic colitis, some patients with concomitant celiac sprue may also respond to a gluten free diet. No pseudomembranes are identified. Immunohistochemical stains for mast cell tryptase demonstrates a mast cell number that is within normal limits.
I have not received my capsule study pathology from this past week. The doctor who reviewed the images called to inform me that the findings were normal, except for some redness towards the distal portion of the small intestine.
Thank you for any support. I do appreciate it more than you know as I tend to be a worry wart over my health.
Love,
Marie
Pathology results, paging Tex ;)
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Hi Marie,
All of the findings noted in your pathology report point to LC (and only LC). Intestinal TB is not likely to be misdiagnosed as MC. However, Intestinal Tb is sometimes misdiagnosed as Crohn's disease (more frequently than GI docs are probably willing to admit).
When your GI doc becomes available, that redness in the distal portion of the small intestine needs to be carefully considered, because intestinal TB tends to favor the terminal ileum. LC can appear as a slightly darker shade of pink than the normal pink pigmentation of a healthy colon, but it shouldn't appear as "redness". Redness suggests either Crohn's, or an infection (possibly intestinal TB, or another mycobacterium species, such as Mycobacterium avium subspecies paratuberculosis (MAP).
It's also very possible that the redness could be left over discoloration from your prior C. diff infection. It takes a while for tissues to recover their normal coloration following a serious infection.
Please try to avoid worrying, that only makes symptoms worse. I realize that's much easier said than done, but trust me, it's never as bad as we visualize it to be when we worry about such things. We always fear the worst, but it virtually always turns out to be something not nearly as serious. Remember, whatever it is, it's treatable.
Love,
Tex
All of the findings noted in your pathology report point to LC (and only LC). Intestinal TB is not likely to be misdiagnosed as MC. However, Intestinal Tb is sometimes misdiagnosed as Crohn's disease (more frequently than GI docs are probably willing to admit).
When your GI doc becomes available, that redness in the distal portion of the small intestine needs to be carefully considered, because intestinal TB tends to favor the terminal ileum. LC can appear as a slightly darker shade of pink than the normal pink pigmentation of a healthy colon, but it shouldn't appear as "redness". Redness suggests either Crohn's, or an infection (possibly intestinal TB, or another mycobacterium species, such as Mycobacterium avium subspecies paratuberculosis (MAP).
It's also very possible that the redness could be left over discoloration from your prior C. diff infection. It takes a while for tissues to recover their normal coloration following a serious infection.
Please try to avoid worrying, that only makes symptoms worse. I realize that's much easier said than done, but trust me, it's never as bad as we visualize it to be when we worry about such things. We always fear the worst, but it virtually always turns out to be something not nearly as serious. Remember, whatever it is, it's treatable.
Love,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Tex,
You never cease to amaze me with your support and abundance of knowledge. I will try to keep calm and carry on until I'm able to speak with my GI. My GI has been ready to throw me in the Crohn's category since day one, so I'm not sure she'll entertain the idea of possible Intestinal TB or MAP....we'll see? She wanted to put me on a biologic over a year ago. Maybe that is what I need if I do have a form of crohn's in the terminal ileum, but I don't want to take those heavy drugs without ruling out infections. I hope there are ways to test the distal portion of my small intestine to determine what it is.
Thank you for this:
You never cease to amaze me with your support and abundance of knowledge. I will try to keep calm and carry on until I'm able to speak with my GI. My GI has been ready to throw me in the Crohn's category since day one, so I'm not sure she'll entertain the idea of possible Intestinal TB or MAP....we'll see? She wanted to put me on a biologic over a year ago. Maybe that is what I need if I do have a form of crohn's in the terminal ileum, but I don't want to take those heavy drugs without ruling out infections. I hope there are ways to test the distal portion of my small intestine to determine what it is.
Thank you for this:
I needed to hear that!!! You're very sweet, thank you.it's never as bad as we visualize it to be when we worry about such things. We always fear the worst, but it virtually always turns out to be something not nearly as serious. Remember, whatever it is, it's treatable.
Marie,
At least part of your terminal ileum was checked when the colonoscopy was done, and the biopsy samples only showed evidence of MC. This phrase (from the pathology report):
This phrase:
Unless someone has HIV, or they are taking an immune system suppressant (especially one of the anti-TNF drugs), and/or they have been traveling in an undeveloped country, intestinal TB is very unlikely.
Regarding the human tendency to always assume the worst: When my symptoms first got out of hand, and I couldn't find any way to stop the D, I was convinced that I had Cancer. I hated to go see a doctor, but after putting it off for another week, I finally decided that I might as well face the music. So after my doctor examined me, and I asked him what he thought was the problem, I wasn't surprised at all when he announced that he thought that I had colon cancer. And then the GI specialist he sent me to told me the same thing. But guess what? All 3 of us were wrong.
You're most welcome,
Tex
At least part of your terminal ileum was checked when the colonoscopy was done, and the biopsy samples only showed evidence of MC. This phrase (from the pathology report):
should rule out Crohn's (at least in the area biopsied). Of course, it's possible for Crohn's and MC to show up in random scattered patches, so if the doctor taking the biopsies happens to take them from the wrong areas, she or he can miss the areas of inflammation. Usually though, doctors can see visual evidence of inflammation through the scope when Crohn's is present, and they will take biopsy samples from those areas, to minimize the chances of missing the diagnosis.with preservation of the villous architecture
This phrase:
Means that no evidence of C. diff was found.No pseudomembranes are identified.
Unless someone has HIV, or they are taking an immune system suppressant (especially one of the anti-TNF drugs), and/or they have been traveling in an undeveloped country, intestinal TB is very unlikely.
Regarding the human tendency to always assume the worst: When my symptoms first got out of hand, and I couldn't find any way to stop the D, I was convinced that I had Cancer. I hated to go see a doctor, but after putting it off for another week, I finally decided that I might as well face the music. So after my doctor examined me, and I asked him what he thought was the problem, I wasn't surprised at all when he announced that he thought that I had colon cancer. And then the GI specialist he sent me to told me the same thing. But guess what? All 3 of us were wrong.
You're most welcome,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.