Beyond the Lungs: A Rare Encounter With Tuberculous Colitis in the Colon

Intestinal tuberculosis is a very rare manifestation of bacterial tuberculosis. Affected patients often present with nonspecific symptoms which could mimic Crohn's disease, intestinal cancer, or amebiasis. Consequently, the presentation of intestinal tuberculosis remains a diagnostic challenge. Here, we report the case of a 27-year-old female with a past medical history of external hemorrhoids who presents to the hospital with complaints of generalized weakness, dizziness, watery diarrhea, significant weight loss, and near syncope. CT abdomen and pelvis with oral contrast revealed colonic wall thickening suggestive of colitis as well as bibasilar reticulonodular opacities and left basilar cavitary lesions concerning for infection with suspicion for mycobacterial organisms. AFB smear was positive for TB. Colonoscopy revealed some ulcers, which were biopsied. Results of the biopsy revealed diffuse granulomatous colitis in the cecum and active granulomatous colitis in the ascending and descending colon. The patient was eventually diagnosed with ITB colitis. Her symptoms improved with antituberculosis medications.