A twenty year old male patient without known comorbidities, who works every day in a cow farm, deep into the mountains. He was grumbling of persistent abdominal pain for around one month in the right iliac fossa, followed by motion sickness, repeated vomit, infrequent dry cough, fatigue, constant night sweats and a total of seven kilograms in weight loss. On inspection, it was observed a slightly expanded abdomen and painful at palpation in the right iliac fossa, related with the presence of a palpable lump in that specific region.
Blood test results within normal range. Chest radiography normal. Abdominal radiography displayed increased air in the small bowel. Abdominal computed tomography unveiled a five centimeters in circumference mass, in the terminal portion of the ileum. The male patient was referred to a gastroenterology department, an immediate colonoscopy was made and histopathological samples where taken. The histopathological analysis of biopsies revealed positive ziel neelsen tuberculous granulomas with central caseiation. Human immunodeficiency virus test negative. Ophthalmology and Otolaryngology consultants did clinical examination on the young male and revealed normal test results.
Based on the regimen proposed by the national guidelines1, successful antituberculous treatment was initiated for a period of six months. It is very crucial for doctors to be aware that intestinal tuberculosis may be considered as differential diagnosis of intestinal diseases, even in immunocompetent patients who present vague abdominal symptoms and relevant physical findings, especially in cases with centered pain and palpable mass in the right lower quadrant of the abdomen, in areas where tuberculosis is endemic like in subregions of Eastern Europe.Dr. Petru-Emil Muntean, MD, Masters Degree