Abdominal tuberculosis in the era of inflammatory bowel disease: the diagnostic challenge of a forgotten disease

• Autores: Jaramillo Trujillo, Gilberto, Marulanda Fernández, Hernando, Frías Ordoñez, Juan Sebastián, Barrero, Jean Sebastián, Otero Regino, William
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Sociedad de Gastroenterología del Perú
• Repositorio: Revista de Gastroenterología del Perú
• Lenguaje: español
• OAI Identifier: oai:ojs.revistagastroperu.com:article/1981
• Enlace del recurso: https://revistagastroperu.com/index.php/rgp/article/view/1981
• Nivel de acceso: acceso abierto
• Materia: Tuberculosis abdominal; Colitis granulomatosa; Enfermedad inflamatoria intestinal; Reacción en cadena de la polimerasa; Diagnóstico diferencial; Colombia; Abdominal Tuberculosis; Granulomatous Colitis; Inflammatory Bowel Diseases; Polymerase Chain Reaction; Differential Diagnosis

Abdominal tuberculosis (ATB) represents a considerable diagnostic challenge due to its nonspecific clinical presentation and resemblance to conditions such as inflammatory bowel disease (IBD) or digestive neoplasms. In endemic regions, timely recognition is crucial to avoid inappropriate immunosuppression and therapeutic delays. Case description: Four immunocompetent adults with ATB were treated at a tertiary-level hospital in southwestern Colombia between January 2023 and May 2025. All presented with chronic diarrhea, abdominal pain, fever, and weight loss. The initial suspicion was Crohn’s disease or infectious colitis. Imaging revealed ileocecal and colonic involvement; endoscopy showed ulcerated lesions, and histology demonstrated granulomatous inflammation with caseous necrosis. Tissue PCR confirmed Mycobacterium tuberculosis infection. In three cases, pulmonary tuberculosis coexisted. All patients received standard antituberculous therapy with favorable outcomes. This series highlights the ability of ATB to mimic IBD and the need to maintain a high index of suspicion in endemic contexts. An integrated approach combining clinical, endoscopic, histological, and molecular evaluation is essential for accurate diagnosis and timely treatment.