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A 68-year-old female with no known comorbidities presented with a three-month history of abdominal pain, nausea, vomiting aggravated by food intake, dry cough, gastro-oesophageal reflux disease, breathlessness, low-grade fever, and significant weight loss. Initial investigations including a plain radiograph of the erect abdomen and contrast-enhanced computed tomography abdomen showed irregular concentric thickening of the large bowel along with proximal dilation of small bowel loops which was suggestive of subacute intestinal obstruction secondary to abdominal tuberculosis (TB). The patient also complained of persistent dry cough for which a chest radiograph and computed tomography (CT) thorax were done which showed features suggestive of pulmonary TB. Conservative management was initiated for subacute intestinal obstruction but persistent cough led to further evaluation with bronchoscopy and transbronchial lung biopsy, revealing invasive mucin-secreting adenocarcinoma. A subsequent PET-CT scan confirmed a large mass in the ileocecal region causing obstruction, multiple iliac lymph nodes, pancreatic and skeletal deposits, and lung opacities indicative of lymphangitis carcinomatosis. Despite the recommendation for exploratory laparotomy, the patient opted for conservative management due to her age and associated risks. This case highlights the importance of clinical symptoms and signs mimicking disseminated TB. Concomitant presence of chronic diseases with overlapping symptoms can lead to diagnostic dilemmas.
Deshmukh et al. (Fri,) studied this question.