Intestinal tuberculosis with perforation in an immunocompetent adult presenting with chronic abdominal pain: A case...

Intestinal tuberculosis is a rare extrapulmonary manifestation of Mycobacterium tuberculosis, often presenting with non-specific symptoms that delay diagnosis, even in immunocompetent individuals. This case report describes the clinical course, diagnostic workup and surgical findings of an immunocompetent adult male who developed intestinal tuberculosis with perforation. The present study reports the case of a 39-year-old male patient with a history of smoking, alcohol consumption, occasional cannabis consumption, poor hygienic practices and a family history of tuberculosis, who developed progressive chronic abdominal pain and significant weight loss. An initial evaluation revealed signs of acute abdomen and cavitary pulmonary lesions. An exploratory laparotomy uncovered an intestinal perforation with caseating granulomas. Histopathological analysis confirmed tuberculosis enteritis with perforation, and anti-tuberculosis therapy was treated with a standard anti-tuberculosis regimen including isoniazid, rifampin, pyrazinamide and ethambutol. The case presented herein underscores the need for the consideration of abdominal tuberculosis in patients with chronic gastrointestinal symptoms, particularly in endemic regions and among individuals with atypical risk factors. It also highlights the diagnostic challenges posed by delayed recognition, exacerbated by the COVID-19 pandemic, and the critical need to strengthen epidemiological surveillance and adherence to prophylactic treatment in exposed individuals. A multidisciplinary approach integrating clinical, radiological and histopathological tools proved essential for accurate diagnosis and comprehensive management.