article · Radiology Case Reports
Intestinal tuberculosis is an uncommon form of extrapulmonary disease that can mimic neoplastic or inflammatory bowel conditions, contributing to diagnostic delays. A 58-year-old man presented with severe unexplained anaemia, weakness, and weight loss in the absence of overt gastrointestinal bleeding. Computed tomography imaging revealed significant involvement of the distal ileum characterised by marked mural thickening, ascites, lymphadenopathy, and uncommon focal pseudoaneurysmal dilatation, creating a pseudotumoral appearance that raised suspicion of lymphoma. Histopathological analysis identified epithelioid and giant-cell granulomas with caseous necrosis. Infection was confirmed via Ziehl-Neelsen staining, mycobacterial culture, and GeneXpert testing, which showed no rifampicin resistance. The patient achieved full clinical, biological, and radiological recovery following standard antituberculous therapy. The findings highlight the importance of combining cross-sectional imaging with microbiological testing to diagnose atypical presentations.
Extrapulmonary tuberculosis can present with features that closely mimic gastrointestinal malignancies, risking misdiagnosis or unnecessary surgery. Recognising rare presentations such as severe anaemia and pseudoaneurysmal dilatation on abdominal scans allows clinicians in endemic areas to consider tuberculosis early. Combining targeted imaging with established microbiological tests ensures accurate diagnosis and enables successful treatment with standard medical therapies.
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Intestinal tuberculosis is an uncommon form of extrapulmonary tuberculosis that may mimic neoplastic or inflammatory disorders, leading to diagnostic delays. In endemic regions, recognition of atypical imaging presentations remains challenging. We report the case of a 58-year-old man with severe unexplained anemia, progressive asthenia, and weight loss without overt gastrointestinal bleeding. Contrast-enhanced abdominal computed tomography revealed focal involvement of the distal ileum extending over approximately 150 mm, characterized by marked circumferential mural thickening measuring up to 41 mm, associated with focal pseudoaneurysmal dilatation, moderate-to-large volume ascites, and mesenteric lymphadenopathy with subtle central necrosis. These findings resulted in a pseudotumoral appearance, raising the differential diagnoses of intestinal tuberculosis and gastrointestinal lymphoma. Histopathological examination demonstrated epithelioid and multinucleated giant-cell granulomas with caseous necrosis. Microbiological confirmation was obtained by positive Ziehl–Neelsen staining, positive GeneXpert MTB/RIF assay for Mycobacterium tuberculosis complex without rifampicin resistance, and positive mycobacterial culture. The patient showed a favorable clinical, biological, and radiological response following standard antituberculous therapy. Ileal tuberculosis may exceptionally present with severe anemia and unusual pseudo-tumoral imaging features, including focal pseudoaneurysmal dilatation. To our knowledge, based on the available literature, this imaging pattern appears to be exceptionally uncommon. Awareness of atypical CT manifestations and correlation with histopathological and microbiological findings are essential for accurate diagnosis and appropriate management, particularly in tuberculosis-endemic areas.
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DOI: 10.1016/j.radcr.2026.07.090
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