Chronic abdominal pain as the sole symptom of colitis tuberculosis: A case report with endoscopic insights and histopathological findings

Abstract

Tuberculous colitis remains a challenging clinical diagnosis because its presentation is often nonspecific and may be mistaken for inflammatory bowel disease (IBD) or colon cancer. A diagnosis may take time to be established, particularly when typical systemic symptoms of tuberculosis are not present. Herein, a case of tuberculous colitis presenting solely with long-standing abdominal pain is reported. The value of combining multiple diagnostic modalities, including endoscopy, biopsy, and GeneXpert testing, in establishing an accurate diagnosis is highlighted. A 25-year-old man was referred to the gastroenterology clinic with chronic abdominal pain that had persisted for 1 year, without fever, diarrhea, or weight loss. On physical examination, no remarkable findings were noted except for mild periumbilical tenderness. Routine laboratory investigations were found to be unremarkable. On colonoscopy, multiple ulcers and polypoid lesions with confluent granulomas in the cecum were identified. On histopathological examination, mucosal erosion, mild crypt distortion, and infiltration of polymorphonuclear cells were observed, favoring neutrophilic cryptitis. Mycobacterium tuberculosis was detected at a very low level by GeneXpert, whereas Ziehl-Neelsen staining was found to be negative. Based on the overall clinical, endoscopic, histopathological, and molecular findings, a diagnosis of tuberculous colitis was established. Chronic abdominal pain, although rare and nonspecific, may be observed as the sole presenting symptom of tuberculous colitis. Diagnostic yield may be increased through a multimodal approach incorporating endoscopy, histopathology, and molecular techniques such as GeneXpert when routine investigations are inconclusive. Tuberculous colitis should be considered an important differential diagnosis in patients with nonspecific gastrointestinal symptoms, particularly in tuberculosis-endemic areas.