Beyond the Lungs - A Rare Encounter With Tuberculous Colitis in the Colon

Sep 28, 2026

Intestinal tuberculosis is an uncommon form of bacterial tuberculosis that often presents with vague symptoms resembling Crohn’s disease, intestinal cancer, or amebiasis, making diagnosis difficult. The case describes a 27-year-old woman with generalized weakness, dizziness, watery diarrhea, marked weight loss, and near syncope. Imaging suggested colitis and suspected mycobacterial infection; AFB smear and biopsy findings confirmed ITB colitis. Symptoms improved after antituberculosis therapy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Abstract

Introduction

Case Presentation

Review began 12/02/2025 Review ended 12/22/2025 Published 01/01/2026 © Copyright 2026 Geha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.100569 Open Access Case Report Beyond the Lungs: A Rare Encounter With Tuberculous Colitis in the Colon Marie Jo Geha 1 , Hassan Buhulaigah 1, Srijana Bajracharya 1, Antonio Topacio 1 , Kevin Chan 1 , Sanja Krajisnik 2 , Olaniyi Fadeyi 1 1. Internal Medicine, West Anaheim Medical Center, Anaheim, USA 2. Pathology, Garden Grove Hospital and Medical Center, Garden Grove, USA Corresponding author: Olaniyi Fadeyi, [olaniyi.fadeyi@yahoo.com](olaniyi.fadeyi@yahoo.com) Abstract Intestinal tuberculosis is a very rare manifestation of bacterial tuberculosis. Affected patients often present with nonspecific symptoms which could mimic Crohn’s disease, intestinal cancer, or amebiasis. Consequently, the presentation of intestinal tuberculosis remains a diagnostic challenge. Here, we report the case of a 27-year-old female with a past medical history of external hemorrhoids who presents to the hospital with complaints of generalized weakness, dizziness, watery diarrhea, significant weight loss, and near syncope. CT abdomen and pelvis with oral contrast revealed colonic wall thickening suggestive of colitis as well as bibasilar reticulonodular opacities and left basilar cavitary lesions concerning for infection with suspicion for mycobacterial organisms. AFB smear was positive for TB. Colonoscopy revealed some ulcers, which were biopsied. Results of the biopsy revealed diffuse granulomatous colitis in the cecum and active granulomatous colitis in the ascending and descending colon. The patient was eventually diagnosed with ITB colitis. Her symptoms improved with antituberculosis medications. Categories: Internal Medicine, Infectious Disease, Gastroenterology Keywords: anti-tuberculosis treatment, diagnostic challenges, extrapulmonary tuberculosis (eptb), inflammatory bowel disease, tuberculosis colitis Introduction Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis complex (MBTC) . Some members of the MBTC include Mycobacterium tuberculosis, Mycobacterium africanum, Mycobacterium bovis, and Mycobacterium canetti. According to the World Health Organization (WHO), TB is one of the leading causes of infectious disease-related deaths worldwide [1] . It primarily affects the pulmonary system, but extrapulmonary manifestations have been seen in several cases. While pulmonary TB accounts for 80% - 85% of all TB cases, extrapulmonary TB has been documented in about 20% of all affected patients [2] . Intestinal tuberculosis (ITB) is a very rare form of extrapulmonary TB seen in only 1-3% of all cases [3] . While ITB is occasionally diagnosed in immunocompetent individuals, the occurrence of ITB is mostly seen in TB endemic areas and among immunocompromised patients [3] . Symptoms of ITB are nonspecific, and unless a high index of suspicion is maintained, the diagnosis can be missed or delayed, resulting in increased morbidity and mortality [4] . Affected patients typically present with nonspecific symptoms (abdominal pain, weight loss, fever, change in bowel habits) which could mimic Crohn’s disease, amoebiasis, or colon cancer [5] . Accurate diagnosis is very crucial to facilitate an appropriate treatment delivery. Wrong or delayed diagnosis could result in complications such as stricture, blockage, colonic perforation, and bleeding [6] . We hereby report the case of a 27-year-old immunocompetent female who presented with generalized weakness, weight loss, watery diarrhea, and dizziness. She was eventually diagnosed with intestinal tuberculosis. Case Presentation A 27-year-old female patient with a past medical history of

FAQs

Why is intestinal tuberculosis difficult to diagnose?

Intestinal tuberculosis often shows nonspecific symptoms that can mimic Crohn’s disease, intestinal cancer, or amebiasis, so clinicians need a high index of suspicion.

What findings supported the diagnosis of tuberculous colitis in the case?

CT imaging suggested colitis and possible mycobacterial infection, AFB smear was positive, and colonoscopy with biopsy showed granulomatous colitis patterns consistent with ITB.

How did the patient respond to treatment?

The patient’s symptoms improved after receiving antituberculosis medications.

Sep 28, 2026

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