MRI shows intestinal mass and TB. What should I do?

Question

Hello doctor,

I have been having gastric issues and after an MRI the doctors identified a mass in my small intestine. They suspected many different things including Crohn's disease and intestinal tuberculosis. I went through different tests, and a couple of days later, the clinic called me to say I probably have TB. I was hoping someone could help me interpret my Quantiferon TB Gold results.

Here are the values:

Nil - 0.09 (reference value less than 8).

IGRA result TB1 - 0.46 (reference value less than 0.35 negative).

IGRA result TB2 - 0.19 (reference value less than 0.35 negative).

Mitogen >10 (reference value more than 0.5).

Quantiferon TB Gold - positive.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Well, to answer your question you have to understand two things.

Test positive but disease negative = False positive result.

Test positive and disease positive = True positive result.

Your test is positive for TB (tuberculosis), but still the disease is not proved, because there is no histopathology testing available, which is considered a gold standard for TB diagnosis.

So to me the best suggestion is to go for histopathological diagnosis. Since you have small intestinal disease the preferred way to go to take biopsy is by colonoscopy, or enteroscopy.

Now the reason behind this small intestinal disease are, of course one is TB, Crohn's, but there are also some others like jejunoileitis, yersinia, and small intestinal lymphoma, immunoproliferative lymph disease, and carcinoid tumor. Look all these disorders can be reasonably established via histopathology testing.

This test has high negative predictive value which means if the test were negative, the TB would have been sufficiently ruled out. But the test has low positive predictive value which means the posititve test does not mean that you have disease unless confirmed with biopsy. Actually, these are some of the implications of the tests that you have. They should be interpreted in a careful and cautious way.

I may provide you a optimal plan of management if you could share the complete CT (computerized tomography) scan abdomen you had, plus relevant information like which symptoms, duration of symptoms, weight loss, fever, night sweats, etc.

You can reach me out via chat, phone, or video consultation. I am sure, at the end we would be in position to plan things strategically.

Thank you.