Synchronous Intestinal Tuberculosis and Ulcerative Colitis: A Diagnostic Challenge

Intestinal tuberculosis (ITB) is a rare manifestation of extrapulmonary tuberculosis that often mimics inflammatory bowel diseases, particularly ulcerative colitis (UC), complicating the diagnostic process. We report the case of a 54-year-old woman with poorly controlled type 2 diabetes who presented with a five-month history of abdominal pain, diarrhea, bloating, fatigue, and low-grade fever. Initial imaging suggested features consistent with inflammatory bowel disease (IBD), and colonoscopy revealed mucosal ulcerations. Histopathological examination confirmed a diagnosis of ITB, and the patient was started on standard anti-tuberculous therapy. However, clinical improvement remained limited. A follow-up colonoscopy six months later demonstrated persistent inflammatory changes, raising suspicion of a coexisting UC. Initiation of mesalamine therapy resulted in significant symptom resolution. This case underscores the diagnostic challenge posed by overlapping gastrointestinal pathologies such as ITB and UC. Timely recognition of coexisting conditions is critical for guiding appropriate treatment and optimizing patient outcomes.