IDDF2020-ABS-0042 Hypertrophic Cecal tuberculosis: a case report

<h3>Background</h3> Gastrointestinal tuberculosis (GITB) remains to be a major health problem in developing countries and results in significant morbidity and mortality. It can present with diagnostic challenges, and a high index of suspicion should be considered specifically in endemic regions. Clinical, radiographic, endoscopic, and histopathologic findings complement one another in establishing the diagnosis. It may involve any part of the gastrointestinal tract. Isolated colonic tuberculosis is less common. The hypertrophic type resembles an inflammatory mass that mimics malignant neoplasm, which can cause intestinal obstruction. It is important to recognize GITB early to prevent complications and the possible need for surgery. We report a hypertrophic type of isolated cecal tuberculosis mimicking colonic malignancy. <h3>Methods</h3> A 56y/o male with chronic renal insufficiency presented with intermittent, colicky abdominal pain associated with changes in bowel movement and weight loss. He presented with fever, a slightly distended abdomen with hyperactive bowel sounds. <h3>Results</h3> Complete blood count revealed anemia (Hgb 9.9 g/dL), leukocytosis (17.3×10⁹/L) and elevated serum creatinine (1166 umol/L). Abdominal CT scan showed ascending colon wall thickening with associated pericecal fat stranding and luminal narrowing. Colonoscopy showed a large mass at the cecum near the ileocecal valve. Histopathology showed chronic granulomatous inflammation with Langhans giant cells and necrosis consistent with cecal tuberculosis. Anti-TB treatment for category 1 extra-pulmonary TB consists of two (2) months of isoniazid, rifampicin, pyrazinamide, and ethambutol (2HRZE) as intensive phase followed by four (4) months of isoniazid and rifampicin (4HR) as continuation phase. <h3>Conclusions</h3> Differential diagnosis of gastrointestinal TB should always be considered in colonic masses producing obstruction among patients in TB-endemic countries. (Figure 1).