Gastric Tuberculosis Masquerading as Persistent Epigastric Pain in an Immunocompetent Patient: A Case Report

Abstract

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a leading infectious disease with varied manifestations. We report a rare presentation of gastric TB in a 50-year-old immunocompetent woman from the Middle East with no prior medical history. The patient presented with persistent epigastric pain, weight loss, nausea, and vomiting over a 2-month duration. Imaging studies and an infectious disease panel were inconclusive. However, upper endoscopy revealed a subepithelial lesion at the pylorus, with biopsies demonstrating caseating granuloma and multinucleated giant cells. A QuantiFERON test was subsequently positive for TB. The patient was successfully treated with standard TB quadruple therapy, resulting in significant improvement in symptoms during follow-up. This case underscores the importance of considering extrapulmonary TB in immunocompetent patients with atypical gastrointestinal symptoms and highlights the efficacy of prompt antitubercular therapy.

Keywords: antitubercular therapy; endoscopic diagnosis; extrapulmonary tuberculosis; gastric tuberculosis; granulomatous lesions; immunocompetent patient.

Figure 1.

(A) shows a polypoid-like lesion protruding from the pylorus toward the gastric antrum, suggestive of a subepithelial mass, while (B) demonstrates diffuse thickening of the gastric mucosa, leading to a narrowed and poorly distensible stomach with features resembling linitis plastica.

Figure 2.

(A) shows an ill-defined nodule with a caseating granuloma under low magnification, characterized by a central area of necrosis, surrounded by aggregates of inflammatory cells, predominantly histiocytes (macrophages), indicating a chronic inflammatory process, while (B) highlights the granuloma structure in greater detail, with high-power magnification of the inflammatory cells. No malignant cells are identified within the sample.