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Key Features

  • Common in developing nations; rare in the United States, except in immigrant groups or in patients with untreated AIDS

  • Caused by Mycobacterium tuberculosis and Mycobacterium bovis

Clinical Findings

  • Active pulmonary tuberculosis in < 50%

  • Most common involvement is ileocecal

  • Chronic abdominal pain, obstructive symptoms, weight loss, diarrhea

  • Abdominal mass palpable

  • Complications include

    • Intestinal obstruction

    • Hemorrhage

    • Fistula formation

  • Differential diagnosis

    • Crohn disease

    • Carcinoma

    • Lymphoma

    • Intestinal amebiasis

Diagnosis

  • PPD skin test may be negative, especially in weight loss or AIDS

  • Abdominal CT

  • Colonoscopy

  • Definitive diagnosis by either endoscopic or surgical biopsy revealing acid-fast bacilli and caseating granuloma or by positive cultures

  • Detection of tubercle bacilli in biopsy specimens by polymerase chain reaction

Treatment

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