Maryana Stryelkina, DO, My Nguyen, DO, Lancaster Weld, DO, Cicily Vachaparambil, MD Baylor Scott & White Medical Center, Temple, TX Introduction: Intestinal tuberculosis (ITB) is rare in developed countries but should be considered in high-risk populations due to its clinical and endoscopic overlap with Crohn’s disease (CD). This case highlights a young female with suspected CD, later diagnosed with ITB and Mycobacterium avium complex (MAC) co-infection. It underscores the importance of thorough microbiologic testing in distinguishing ITB from inflammatory bowel disease (IBD).
Case Description/
Methods: A 30-year-old woman, born in Lebanon and living in Ecuador for 10 years, presented with a month of abdominal pain, nausea, vomiting, and fevers. CT showed terminal ileal hyperenhancement, suggesting CD. Despite steroids, symptoms persisted. Labs showed elevated CRP (134 mg/L), negative autoimmune and infectious serologies, and a positive TB Quantiferon. Colonoscopy revealed ileal erosions and colitis with ulceration. Biopsies showed non-necrotizing granulomas, and AFB staining and PCR confirmed Mycobacterium tuberculosis and MAC. She was treated with RIPE therapy (rifampin, isoniazid, pyrazinamide, ethambutol) and azithromycin for MAC, with symptom resolution.
Discussion: ITB and CD share clinical and endoscopic features, including granulomas and ulceration, making differentiation challenging. While CD typically shows non-caseating granulomas, ITB may present with caseating granulomas and AFB. This case highlights the diagnostic value of AFB staining and PCR in patients with high-risk exposures or poor response to CD therapy. Early recognition and appropriate treatment of ITB are crucial to prevent complications and improve outcomes.
Figure: Figure 1. (A) Colonoscopy showing terminal ileal erosions and moderate ascending colitis with erythema, friability, and ulceration. (B) Histology of ileum with active ileitis, ulceration, and non-necrotizing granulomas. (C) AFB stain positive for acid-fast bacilli.
Disclosures: Maryana Stryelkina indicated no relevant financial relationships. My Nguyen indicated no relevant financial relationships. Lancaster Weld indicated no relevant financial relationships. Cicily Vachaparambil indicated no relevant financial relationships.
Maryana Stryelkina, DO, My Nguyen, DO, Lancaster Weld, DO, Cicily Vachaparambil, MD. P3396 - Unraveling the Diagnosis: Mycobacterial Infection Presenting as Suspected Inflammatory Bowel Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
