Multiple, large granulomas in a patient with extensive intestinal tuberculosis

A 42-year-old patient presented with low-grade fever, pain of the right iliac fossa, constipation and tendency to vomit. Clinical examination revealed abdominal wall rigidity and rebound tenderness of the right iliac fossa. The patient was operated immediately because of an acute abdomen and the probable diagnosis of ruptured appendicitis. In laparotomy, terminal ileum, ileocaecal valve and the entire ascending colon, up to the right colic flexure, were occupied and distorted by multiple, large masses. In addition, many enlarged lymph nodes were scattered in the mesentery and the mesocolon. A right hemicolectomy was performed. Pathological examination of biopsy specimens revealed findings compatible with tuberculosis. The patient was started on empirical anti-tuberculosis treatment with a four-drug regimen. He was discharged 10 days later with marked improvement. Six months after surgery, the patient remains in very good condition without any symptoms.