A 55-year-old woman was admitted to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) with a 30-year history of rheumatoid arthritis (RA). She declared a hypogastric, nonpositional pain without any relation to defecation or feeding, for 2 months, with previous constipation (had been cured with lactulose). Each pain episode lasted for ~5-10 minutes. She had a weight loss of 20 kg over the last 7 months. Also, had undergone endoscopy the previous year for the symptoms of nausea, diarrhea, and epigastric pain with eradicated Helicobacter pylori gastritis after a 4-week treatment. Although she had chronic anemia, there was no history of drinking alcohol or smoking, diabetes mellitus, cardiovascular disease, hyperlipidemia, or hypertension. In addition, she took prednisolone 5 mg, hydroxychloroquine 20 mg, hematinic, and supplements such as calcium, folic acid, and multivitamins daily. Furthermore, a self-discontinuation of methotrexate (MTX) was noted. The colonoscopy was performed, and only an ulcerated mass in the hepatic flexure was seen, and a biopsy was taken. As the endoscope could not pass through the hepatic flexure, the procedure was stopped (Figure 1). The pathobiological features revealed ulceration and granulation tissue formation, foci of necrotizing granulomatous inflammation in lamina propria with adjacent mild crypt regenerative changes (Figure 2). Moreover, Ziehl-Neelsen stained sections (Figure 3) revealed few acid-fast positive bacilli in the granuloma. No evidence of dysplasia or malignancy was found in the received sample. Meanwhile the polymerase chain reaction (PCR) for ITB was negative. In order to rule out pulmonary TB, radiography was performed with no evidence of pulmonary involvement (Figure 4). Follow-up after a 2 week treatment with anti-TB medication demonstrated the complete disappearance of the symptoms. A written informed consent form has been provided by the patient to have the case details and any accompanying images published.