Intestinal Tuberculosis Presenting with Gastrointestinal Bleeding in Patient on Warfarin Therapy

Abstract

Background: Intestinal tuberculosis (ITB) constitutes less than 5% of overall cases of extrapulmonary disease and mostly affects the ileocecal region. The presentation and radiologic findings in enteric tuberculosis can mimic Crohn's disease (CD). Case Presentation. We present a case report of an African woman who presented to a Kenyan hospital with lower gastrointestinal bleeding while on anticoagulation for valvular atrial fibrillation, and was diagnosed with intestinal tuberculosis after colonoscopy, biopsy, and positive staining for tuberculous bacilli.

Conclusion: Intestinal tuberculosis causing gastrointestinal bleeding is rare but should be suspected in patients living in TB endemic regions.

Figure 1

Colonoscopy: ulcerations and polyps in the ileocecal region and ascending colon.

Figure 2

CT chest axial image showing bilateral lung consolidations.

Figure 3

Colonic biopsies. (a) Lamina propria shows expansion by inflammatory cells. A lymphoid aggregate (red asterix), nonneoplastic colonic glands (red dashed arrow), and granuloma are seen (yellow dashed line) (hematoxylin and eosin, original magnification x100). (b) Goblet mucin component decreased as well as cryptitis. Edge of granuloma is seen here (original magnification x200). (c) Acid-fast bacilli (black arrows) (Ziehl–Neelsen stain).