Tuberculosis in the Terminal Ileum Masquerading as Inflammatory Bowel Disease: A Case Report

: Introduction Abdominal tuberculosis can masquerade as multiple other diagnoses, including Crohn’s disease; while they are similar in that they are both chronic granulomatous diseases commonly affecting the terminal ileum, they require completely different management. Case presentation A 15 year old female from Malaysia initially presented with abdominal pain. Work-up demonstrated stricturing at the terminal ileum with inflammatory changes and biopsies suggestive of Crohn’s disease. She was started on budesonide and infliximab. She re-presented to the hospital twice with obstructive-type symptoms, and computed tomography of the abdomen and pelvis demonstrated a mesenteric fistula along the terminal ileum with associated phlegmon and small abscess along with a small splenic abscess. Additional workup included a weakly positive quantiferon tuberculosis blood test and three negative sputum samples. A multidisciplinary care conference was held, and the patient underwent a single incision laparoscopic-assisted ileocecectomy through a vertical incision confined to the borders of the umbilicus. Peritoneal attachments were taken with bipolar electrocautery and blunt dissection, and the cecum was delivered extracorporeally. The inflamed ileum and cecum were resected, and a stapled side to side ileocolic anastomosis was created. Pathology of the peritoneal fluid, mesenteric lymph nodes, mesentery, and resected bowel specimens confirmed the diagnosis of abdominal tuberculosis. The patient recovered well following her surgery with an extended course of antibiotics. Conclusion Abdominal tuberculosis should be considered in the differential diagnosis of patients with inflammatory bowel disease refractory to therapy, particularly in patients from tuberculosis-endemic regions.