Gastrointestinal Tuberculosis Presenting as Malnutrition and Distal Colonic Bowel Obstruction

Abstract

Gastrointestinal (GI) tuberculosis (TB) is rare and can occur in the context of active pulmonary disease or as a primary infection with no pulmonary symptoms. It typically presents with vague abdominal symptoms, making it difficult to discern from alternative disease processes. Although the ileocecal region is the most commonly affected site, tuberculous enteritis can involve any aspect of the GI tract. To demonstrate the importance of maintaining a high clinical suspicion for the disease, we present a case of GI TB presenting as severe malnutrition and segmental colitis of the left colon.

You have gut TB kidding me

“… 7 It has been noted that in some cases (including our own patient) biopsies result with elevated tumor markers. 7 For instance, our patient had an elevated CA-125 marker. For these reasons, abdominal tuberculosis has been noted as “the great mimicker” by many clinicians and researchers.…”

“…This disease can appear clinically similar to gastric cancer, lymphomas, peritoneal carcinomas, Crohn’s disease, and sarcoidosis. 7 This is due in part to the lesions seen with abdominal tuberculosis ability to show uptake of radioactive dye used in PET scans as well as this disease’s ability to exhibit non-specific CT imaging findings (sometimes presenting as non caseating granulomas or caseating granulomas). 7 Patients often undergo regional biopsies, however, this too can be misleading.…”

“… 7 This is due in part to the lesions seen with abdominal tuberculosis ability to show uptake of radioactive dye used in PET scans as well as this disease’s ability to exhibit non-specific CT imaging findings (sometimes presenting as non caseating granulomas or caseating granulomas). 7 Patients often undergo regional biopsies, however, this too can be misleading. 7 It has been noted that in some cases (including our own patient) biopsies result with elevated tumor markers.…”

“… 7 Patients often undergo regional biopsies, however, this too can be misleading. 7 It has been noted that in some cases (including our own patient) biopsies result with elevated tumor markers. 7 For instance, our patient had an elevated CA-125 marker.…”

Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital

“…On histopathology, the initial lesions in both ITB and CD first involve the mucosa of the bowel 18,21,22 . Granulomas in ITB are more confluent with lymphoid cuffing and disproportionate amounts of submucosal inflammatory cell infiltrate and may show caseation necrosis; granulomas of CD show a more discrete distribution.…”