A 46 year old female patient came walking to the outpatient department with a 6 month history of diffuse abdominal pain with low grade fever and loss of appetite and weight. No significant past medical or surgical history. There was no history of pulmonary tuberculosis.
On examination, general condition was fair, vitals were stable. Abdominal examination revealed a soft non tender abdomen with a normal digital per rectal examination.
Haematological investigations were normal except erythrocyte sedimentation rate(ESR) which was 80 mm (0-30 mm normal). Her serum levels of carcinoembryonic antigen(CEA), cancer antigen19-9(CA 19-9) and serum adenosine deaminase(ADA) levels were within normal limits.
Contrast enhanced CT(CECT) abdomen revealed a diffuse concentric long segmental circumferential wall thickening of terminal ileum, ileocaecal(IC) junction and ascending colon with peripheral fat stranding and lymphadenopathy with narrowing at the splenic flexure (Fig. 1, Fig. 2, Fig. 3 ).
Colonoscopy showed an ulceronodular lesion with lumen compromise at the splenic flexure and thickening of the ileocaecal junction. Biopsy was taken from both the sites and sent for histopathological examination and also for culture and gene xpert for MTB.
Pathology showed moderate mixed inflammation and occasional lymphoid collection in the lamina propria with no evidence of malignancy. There were also occasional crypt abscesses which raised suspicion of inflammatory bowel disease. The final diagnosis of tuberculosis of the intestine was made as the biopsy smear showed AFBs and the Gene Xpert detected MTB. The patient was/started on Anti tubercular therapy. At 6 month follow up, patient is asymptomatic. Repeat CT scan shows no narrowing (Fig. 4).