Intestinal Tuberculoma Masquerading as a Lipoma

Abstract

Purpose: Tuberculosis is rapidly becoming a more common disease in the West. With a myriad of clinical presentations, gastroenterologists must recognize the importance of intestinal involvement. A 66 year old male with past medical history underwent a screening colonoscopy. He had a 30 pack year smoking history. He served 1 year in Vietnam. Review of symptoms was significant for frequent cough attributed to “smokers cough”. Physical examination and routine laboratory was unremarkable. Colonoscopy revealed a submucosal mass consistent with a lipoma (image 1) with a positive “pillow sign” (image 2). Histologic staining revealed Acid Fast Bacilli (AFB). The patient was treated with combinational drug Tuberculosis (TB) regimen complete resolution of cough and submucosal mass. TB is a disease with many different clinical presentations. The gastrointestinal tract is the most common extra-pulmonary site with non-specific symptoms. Colonoscopy aids our ability to diagnose intestinal TB. The endoscopic findings of intestinal TB are often difficult to distinguish from Crohn's disease and most commonly include circular ulcers, small diverticula (3-5 mm) and sessile, firm polyps. Biopsies demonstrating AFB confirm the diagnosis. The most affected area is the ileocecal region. This case represents an atypical tuberculoma masquerading as a lipoma. This case illustrates that in the right clinical setting there should be a high index of suspicion for TB with any mass in the ilecocecal region.Figure: Positive “pillow sign”.