The Elusive Face of Intestinal Tuberculosis: Insights from a Rare Case and Comprehensive Literature Review

Background: Intestinal tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis but remains clinically relevant in endemic countries such as Mexico. It may involve any segment of the gastrointestinal tract, most frequently the ileocecal region, and often presents with nonspecific symptoms, which may delay diagnosis and increase the risk of complications. Case Report: A 20-year-old male with no significant medical history presented with a one-month history of asthenia, fatigue, weight loss, fever, cough, and diarrhea. He was admitted due to hematochezia and syncope, with evidence of hemodynamic instability and severe anemia. Imaging studies revealed findings compatible with pulmonary tuberculosis, and sputum smear microscopy confirmed Mycobacterium tuberculosis. Colonoscopy demonstrated lesions in the ileum and ileocecal valve. Histopathological examination and polymerase chain reaction (PCR) of biopsy specimens were positive for intestinal tuberculosis. Antituberculous therapy was initiated, leading to clinical improvement, resolution of gastrointestinal bleeding, and progressive recovery. At three-month follow-up, the patient remained asymptomatic with weight gain. Conclusions: Intestinal tuberculosis poses a diagnostic challenge due to its nonspecific clinical presentation. Diagnosis requires integration of clinical findings, imaging studies, endoscopy, and histopathological and microbiological confirmation. In endemic regions, a high index of suspicion is essential to ensure early diagnosis, prompt treatment, and prevention of complications.