Ileal biopsies from a 30-year-old man with chronic diarrhea, right iliac fossa pain, and low-grade fever show epithelioid cell granulomas. Which single finding on histology best supports intestinal tuberculosis over Crohn's disease as the diagnosis?

• A Confluent caseating granulomas with acid-fast bacilli on stain ✓
• B Non-caseating granulomas away from crypts
• C Transmural lymphoid aggregates with fissuring ulcers
• D Focal cryptitis with architectural distortion

Explanation

Intestinal tuberculosis shows large, confluent, caseating granulomas with Langhans giant cells, and acid-fast bacilli may be demonstrated on Ziehl-Neelsen stain or PCR. Crohn's granulomas are small, sparse, non-caseating, and AFB stains are negative. Because tuberculosis is far more prevalent than Crohn's in India, Indian practice mandates excluding TB before committing to immunosuppressive therapy for suspected Crohn's disease.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.