A thirty-five-year-old female presented with complaints of per rectal bleeding mixed with stools. She had recurrent episodes associated with crampy lower abdominal pain over a period of five days. Upon further enquiry, she also reported a history of productive cough for three months, night sweats, and weight loss of ten kilograms over the same period. Her medical history was significant for rheumatic heart disease and atrial fibrillation. The patient had a surgical history of mitral valvuloplasty two years prior to her current presentation. Her regular medications included warfarin 5 mg daily, carvedilol 25 mg twice daily, and furosemide 40 mg daily. The examination revealed a sick-looking middle-aged female who had pallor, bipedal edema, and no palpable lymphadenopathy. The precordial examination was positive for features of mitral stenosis and aortic regurgitation. Abdominal examination did not elicit any tenderness or palpable mass. Investigations done included a complete blood count with the following results: white cell count 9.24 x 109/L, hemoglobin 5.30 g/dL, and platelets 572 x 109/L. The prothrombin time was prolonged, and the international normalized ratio (INR) was 2.78. Renal and hepatic function tests were normal. Initial management involved withholding of warfarin and transfusion of three units of packed red cells. An urgent colonoscopy performed to evaluate hematochezia revealed segmental inflammation of the ascending colon with ulcerations and polyps covered with yellowish exudate, a distended ileocecal junction, and an aberrant vascular pattern with mucosal edema extending to the hepatic flexure (Figure 1). At endoscopy, the differential diagnoses were tuberculosis or CD. In view of her respiratory complaints and accompanying systemic symptoms, a computed tomography (CT) of the chest and abdomen was performed, which demonstrated right lung consolidation, focal subsegmental consolidations in the left lung, and subcentimeter-sized lymph nodes in the small bowel mesentery (Figure 2). Given her history of chronic cough and chest imaging findings, a sputum test was requested whose staining was acid-fast bacilli (AFB) positive. Biopsies of the samples obtained during colonoscopy revealed lymphocytic infiltration, necrotizing granulomas, and positivity for AFB (Figure 3). Serologic testing for human immunodeficiency virus (HIV) was negative. A diagnosis of pulmonary and extra pulmonary tuberculosis with gastrointestinal involvement was established. The patient was initiated on the intensive phase of antituberculous therapy consisting of rifampicin (600 mg/day), isoniazid (300 mg/day), ethambutol (800 mg/day), and pyrazinamide (1 g/day). Warfarin 5 mg daily was reinstituted prior to her discharge after a five-day hospital admission. The culture in Lowenstein-Jensen medium later isolated Mycobacterium tuberculosis complex, which was susceptible to the first-line drugs. She is followed up at the outpatient clinic with regular INR checks to ensure a therapeutic INR range of 2.0-3.0. Her warfarin dosage was increased from the initial 35 mg/week to 52.5 mg/week by the fourth week after discharge.