P2489 - Tuberculosis and Granuloma Drama: Solving the Mystery of Rectal Bleeding

Abdulazeez Swaiti, MD¹, Jinye Liu, DO², Stephanie Ibarra Lepe, MD², Christin Wilkinson, MD¹, Christina Santana, MD², Saeed Graham, MD¹, Amy Chang, MD², Matthew Tugman, BA³, Catherine Gray, BS³, Michelle Cooley, BS³, Zarak Khan, MD⁴, Rahul Pamarthy, MD¹, Hassam Ali, MD¹, Danielle Hoo-Fatt, MD⁴, Prashant Mudireddy, MD^4
1East Carolina University, Greenville, NC; ²East Carolina University Medical Center, Greenville, NC; ³East Carolina University Brody School of Medicine, Greenville, NC; ⁴East Carolina Gastroenterology, Greenville, NC

Introduction: Despite global efforts to eradicate tuberculosis (TB), it remains a leading cause of death worldwide. TB primarily affects the lungs but can seed and become extra-pulmonary tuberculosis (EPTB), accounting for 15-20% of cases. Gastrointestinal tuberculosis (GITB) is rare, accounting for 1% to 5% of all EPTB infections, affecting mostly the ileocecal region and presenting with symptoms like abdominal pain, nausea, diarrhea, and weight loss.



Diagnosis involves clinical history, lab work, and endoscopies, with biopsies having up to 80% accuracy. AFB presence, positive cultures, or evidence of TB in other organs may aid diagnosis. High clinical suspicion warrants starting antituberculosis therapy, even with negative tests, to prevent life-threatening consequences.

Case Description/Methods: A 25-year-old male presented with nausea, vomiting, and unintentional weight loss for two months, with increasing severity over the last few days. He had no past medical history. Imaging studies revealed extensive bilateral pulmonary nodular densities, prominent mediastinal lymph nodes, cystic masses of the pancreatic head and neck, and significant intra- and extra- hepatic biliary ductal distention. While awaiting endoscopy he had two episodes of hematochezia followed by a syncopal episode. Imaging revealed active hemorrhage in the right colon. He was transfused three units of red blood cells before undergoing cecal artery embolization. Lymph node biopsy revealed the patient had active TB. Once stabilized, he underwent colonoscopy and endoscopy. Colonoscopy revealed cecal ulcers which required clips. Biopsies revealed the presence of H. pylori (HP) in the stomach and granulomas in the colon. Patient was started on anti-TB and anti-HP therapy and was discharged.

Discussion: Colonic TB, although rare in developed countries, is common in developing countries. As emigration to developed countries increases, the prevalence of TB and GITB increases as well. Current literature suggests that acid-fast bacilli are infrequently isolated from colonic biopsies, however the presence of granulomas as well as a patient’s resolution of symptoms with anti-TB therapy can confirm the diagnosis of GITB. Our patient’s clinical presentation and histopathology raised suspicions for possible inflammatory processes such as sarcoidosis, however, this is less likely considering he had complete resolution of his symptoms once completing his anti-TB therapy.



Disclosures:


Abdulazeez Swaiti, MD¹, Jinye Liu, DO², Stephanie Ibarra Lepe, MD², Christin Wilkinson, MD¹, Christina Santana, MD², Saeed Graham, MD¹, Amy Chang, MD², Matthew Tugman, BA³, Catherine Gray, BS³, Michelle Cooley, BS³, Zarak Khan, MD⁴, Rahul Pamarthy, MD¹, Hassam Ali, MD¹, Danielle Hoo-Fatt, MD⁴, Prashant Mudireddy, MD⁴. P2489 - Tuberculosis and Granuloma Drama: Solving the Mystery of Rectal Bleeding, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.