Beyond the Flare: A Case of Disseminated Tuberculosis and Thrombosis Masquerading as IBD Exacerbation

Differentiating inflammatory bowel disease (IBD) flares from infectious complications in patients on anti-TNFα therapy presents a significant diagnostic challenge. This case report describes a 54-year-old woman with ileocolic Crohn's disease on adalimumab who presented with systemic and gastrointestinal symptoms mimicking a flare. Initial computed tomography revealed enteritis, mesenteric lymphadenopathy, and extensive inferior vena cava thrombosis. Despite treatment with corticosteroids and broad-spectrum antibiotics, the patient developed respiratory symptoms. Further evaluation confirmed disseminated tuberculosis (TB) through PCR and culture from a bronchoalveolar lavage and histopathological analysis of a lymph node. Adalimumab was discontinued, and the patient was successfully treated with anti-tuberculous therapy and anticoagulation, leading to progressive clinical improvement. This case underscores the importance of a broad differential diagnosis in immunosuppressed IBD patients, as opportunistic infections like TB can mimic IBD flares and require invasive diagnostics for definitive confirmation, especially when systemic symptoms and thrombosis are present.