Abdominal Tuberculosis

Tuberculosis remains a deadly global health problem, especially in developing nations. Extrapulmonary manifestations are prevalent in these endemic areas and on the contrary, are usually limited to the immunocompromised and immigrants in the Western world. In the United States, abdominal infection is even more exceptional, which can be problematic to clinicians in view of its non-specific presentation and investigatory findings. In this case, a 60-year-old Hispanic-American female presenting with a three-month history of abdominal pain, nausea and vomiting who was referred for an elective screening colonoscopy. Her physical and laboratory studies were unremarkable and her chest x-ray was negative. Furthermore, the patient had negative PPDs on two separate occasions. Contrast computed tomography of the abdomen showed scarring of the right lung base and sigmoid diverticulosis. The screening colonoscopy revealed two polyps and a cecal ulcer. Histological studies of biopsy samples obtained from the cecal ulcer conclusively documented the existence of gastrointestinal tuberculosis. This case illustrates the subtle and indefinable course of abdominal tuberculosis. While it can commonly mimic diseases such as inflammatory bowel disease or colon carcinoma, it can also follow a more indistinct pattern as well, particularly in the acute stages.