1850 Intestinal Tuberculosis in an Immunocompetent Patient

Abstract

INTRODUCTION: Intestinal tuberculosis (TB) is a rare disease in western countries usually only affecting immigrants from endemic areas and those that are immunocompromised. Diagnosis is challenging especially when pulmonary symptoms are absent as it can mimic other abdominal pathologies, notably Crohn’s disease. It is especially important to distinguish between Crohn’s and TB since treatments greatly differ. Intestinal TB favors the small bowel, particular the small ileum due to its affinity for Peyer’s patches. Biopsies positive for acid-fast bacilli confirms the diagnosis. Our case describes an immunocompetent patient diagnosed with intestinal TB that was initially thought to be Crohn’s disease. CASE DESCRIPTION/METHODS: A 79-year-old male with a history of TIA, seizure disorder and achalasia presented to the hospital with acute encephalopathy and sepsis. Chest x-ray revealed bilateral infiltrates and the patient was treated for pneumonia. Incidental finding on CT chest, abdomen and pelvis revealed terminal ileitis and an ileocecal valve mass. The patient underwent colonoscopy which showed a terminal ileum and ileal cecal valve lesion with sigmoid stricture and severe left sided diverticulitis. Biopsies were taken that were significant for non-necrotizing granulomas concerning for infectious etiology or Crohn’s disease. The patient was referred to Colorectal Surgery and underwent laparoscopic right hemicolectomy. Surgical pathology revealed extensive granulomas positive for acid-fast bacilli (AFB) secondary to Mycobacterium tuberculosis (TB). Prior to these findings, the patient denied prior TB exposure, travel to TB endemic countries, previous incarceration, pulmonary symptoms, fevers, weight loss, diarrhea, constipation, melena, hematochezia, alcohol or illicit drug use. The patient underwent bronchoscopy with cultures positive for AFB. The patient then began treatment for active TB with a four-drug regimen. DISCUSSION: Though rare, intestinal tuberculosis should be kept on the differential when evaluating chronic intestinal diseases. Proper knowledge and anticipation of intestinal manifestations of systemic disease should be mandatory due to the vast differences in treatment. Though diagnosis is difficult in the absence of active symptoms, intestinal tuberculosis should be considered especially in metropolitan areas. Endoscopic evaluation is the mainstay of diagnosis and should be promptly considered to differentiate it from other abdominal pathologies.