Title : Tuberculous colitis with chronic abdominal pain: A case report
Abstract:
Background: Intestinal tuberculosis is an uncommon form of extrapulmonary tuberculosis that may mimic inflammatory bowel disease and other gastrointestinal conditions. Diagnosis can be particularly challenging when concomitant pulmonary tuberculosis is clinically silent and gastrointestinal symptoms predominate.
Case Presentation: A 32-year-old man presented with recurrent abdominal pain, progressive weight loss, night sweats, and anemia five months after undergoing appendectomy for suspected acute appendicitis. Chest and abdominal computed tomography revealed a tree-in-bud pattern, bilateral upper-lobe consolidations, and mediastinal and mesenteric lymphadenopathy. Colonoscopy demonstrated ulcerated and friable mucosa involving the terminal ileum and cecum. Bronchoalveolar lavage polymerase chain reaction was positive for Mycobacterium tuberculosis, while histopathological examination of ileocecal biopsies demonstrated chronic granulomatous inflammation and acid-fast bacilli. Concomitant pulmonary and intestinal tuberculosis was diagnosed, and standard four-drug antituberculous therapy was initiated. After one month, the patient showed clinical and radiological improvement.
Discussion: This case illustrates the diagnostic challenge of intestinal tuberculosis due to its nonspecific clinical, radiological, and endoscopic manifestations. The predominance of abdominal symptoms despite active pulmonary disease contributed to an initially gastrointestinal-focused evaluation. Persistent abdominal pain, constitutional symptoms, ileocecal involvement, and mesenteric lymphadenopathy should raise suspicion for intestinal tuberculosis, particularly in tuberculosis-endemic or moderate-incidence settings. Integration of pulmonary imaging, endoscopic findings, histopathology, and microbiological testing was essential to establish the diagnosis.
Conclusion: Intestinal tuberculosis should be considered in patients with chronic abdominal pain, weight loss, and ileocecal abnormalities, even in the absence of respiratory symptoms. A comprehensive systemic evaluation may facilitate earlier diagnosis and treatment and reduce the risk of disease-related complications.
Keywords: Intestinal Tuberculosis; Pulmonary Tuberculosis; Ileocecal Tuberculosis; Chronic Abdominal Pain; Extrapulmonary Tuberculosis; Case Report
