A 42-year-old man experienced recurrent abdominal pain and weight loss (15 kg) in 2 years. The diagnosis of CD was made on the basis of abdominal computed tomography (ACT), barium radiographic study of small bowel, and colonoscopic findings. ACT showed skip lesions throughout the small bowel, and suspected healed enteroenteric fistula with multifocal mesenteric adhesion (Figure 1a). Barium radiographic study revealed segmental narrowing of ileum which favored post-inflammatory focal stricture (Figure 1b). Colonoscopic examination showed the presence of polypoid lesions in the terminal ileum (Figure 1c), of which two pieces were biopsied. The pathologic report was chronic inflammatory change without the presence of microorganism. Under the impression of CD, prednisolone and azathioprine were then prescribed but yielded a poor response. He presented to our emergency room with diffuse abdominal pain and intermittent fever 4 months after the initiation of treatment for CD. ACT revealed pneumoperitoneum and hollow organ perforation; the perforated site at the terminal ileum was confirmed by emergent laparotomy. Segmental small bowel resection with end ileostomy was performed for the small bowel perforation. The pathologic report showed granulomatous inflammation with the presence of acid-fast bacilli at the perforated site (Figure 2). Miliary TB was diagnosed with additional positive findings of polymerase chain reaction (PCR) and positive culture for Mycobacterium tuberculosis in sputum, stool, and ascites. Tracing back the initial presentation and medical history, no clue of tuberculosis was yielded in early plain films and in clinical presentation. Standard anti-TB treatment was initiated and the patient's body weight increased, with drastic improvement in abdominal symptoms. Follow-up barium radiographic examination of the intestine (Figure 1d, left) showed no definite residual lesion after completion of his 6-month-course of anti-TB treatment. His body weight returned to his baseline weight of 65 kg, 2 months after ileostomy closure, and there were no abdominal complaints thereafter.