Gut Check: Gastrointestinal Tuberculosis as a Potential Mimic of Another Disease

Gastrointestinal tuberculosis (GI TB) is an uncommon form of extrapulmonary TB (EPTB). While it is more prevalent in endemic regions, its incidence is rising in developed countries due to factors such as immigration, HIV infection, and immunosuppressive therapy. We present a case of a 34-year-old woman with abdominal pain, nausea, and unintentional weight loss who was found to have imaging evidence of terminal ileal and colonic wall thickening, peritoneal thickening, and ascites, and was ultimately diagnosed with gastrointestinal TB after an endoscopic biopsy demonstrated noncaseating granulomatous ileitis, a cecal ulcer, and a positive GeneXpert Mycobacterium tuberculosis polymerase chain reaction (MTB-PCR) result in sputum. This report highlights an unusual presentation characterized by a nonproductive cough and the absence of typical risk factors or manifestations of pulmonary TB. It underscores the importance of considering TB in the broad differential diagnosis for individuals with nonspecific symptoms, as it may mimic inflammatory bowel disease. The patient demonstrated a favorable response to anti-TB treatment, highlighting the significance of early detection and appropriate management of this uncommon disease. We believe this report contributes to the growing body of literature on extrapulmonary manifestations of TB.