Intestinal tuberculosis is an uncommon but clinically significant manifestation of tuberculosis that often presents with nonspecific gastrointestinal symptoms. Although the ileocecal region is most frequently involved, overt gastrointestinal bleeding is an unusual presentation, particularly in elderly patients who may lack classic constitutional symptoms. An elderly man presented to a community hospital in Guam with hematochezia one week after the diagnosis of pulmonary tuberculosis and initiation of rifampin, isoniazid, pyrazinamide, and ethambutol. Colonoscopy revealed a large semi-circumferential ulcer in the terminal ileum with a non-bleeding visible vessel. Histopathologic evaluation demonstrated necrotizing granulomatous inflammation, and acid-fast bacilli staining confirmed mycobacterial infection, establishing the diagnosis of intestinal tuberculosis. Despite appropriate anti-tuberculous therapy, the presence of concurrent pulmonary and intestinal disease reflected an advanced disease burden and poor prognosis. Given advanced frailty and clinical status, the patient and his family elected to pursue comfort-focused care. This case highlights intestinal tuberculosis as an uncommon cause of gastrointestinal bleeding and emphasizes its diagnostic overlap with conditions such as Crohn's disease. It underscores the importance of biopsy in granulomatous ileal disease and the need to maintain clinical suspicion for tuberculosis, particularly in patients from endemic regions or with relevant epidemiologic risk factors.
Abstract
Case Reports
Journal Article
eng
42083694
Day, James M.. "When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia." Cureus, vol. 18, no. 4, 2026, pp. e106399.
Day JM. When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia. Cureus. 2026;18(4):e106399.
Day, J. M. (2026). When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia. Cureus, 18(4), e106399. https://doi.org/10.7759/cureus.106399
Day JM. When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia. Cureus. 2026;18(4):e106399. PubMed PMID: 42083694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - When Tuberculosis Bleeds: Intestinal Tuberculosis Presenting With Hematochezia.
A1 - Day,James M,
Y1 - 2026/04/03/
PY - 2026/04/03/accepted
PY - 2026/5/5/medline
PY - 2026/5/5/pubmed
PY - 2026/5/5/entrez
KW - extra-pulmonary tuberculosis (eptb)
KW - gastrointestinal tuberculosis
KW - guam
KW - hematochezia
KW - intestinal tuberculosis
SP - e106399
EP - e106399
JF - Cureus
JO - Cureus
VL - 18
IS - 4
N2 - Intestinal tuberculosis is an uncommon but clinically significant manifestation of tuberculosis that often presents with nonspecific gastrointestinal symptoms. Although the ileocecal region is most frequently involved, overt gastrointestinal bleeding is an unusual presentation, particularly in elderly patients who may lack classic constitutional symptoms. An elderly man presented to a community hospital in Guam with hematochezia one week after the diagnosis of pulmonary tuberculosis and initiation of rifampin, isoniazid, pyrazinamide, and ethambutol. Colonoscopy revealed a large semi-circumferential ulcer in the terminal ileum with a non-bleeding visible vessel. Histopathologic evaluation demonstrated necrotizing granulomatous inflammation, and acid-fast bacilli staining confirmed mycobacterial infection, establishing the diagnosis of intestinal tuberculosis. Despite appropriate anti-tuberculous therapy, the presence of concurrent pulmonary and intestinal disease reflected an advanced disease burden and poor prognosis. Given advanced frailty and clinical status, the patient and his family elected to pursue comfort-focused care. This case highlights intestinal tuberculosis as an uncommon cause of gastrointestinal bleeding and emphasizes its diagnostic overlap with conditions such as Crohn's disease. It underscores the importance of biopsy in granulomatous ileal disease and the need to maintain clinical suspicion for tuberculosis, particularly in patients from endemic regions or with relevant epidemiologic risk factors.
SN - 2168-8184
UR - https://www.unboundmedicine.com/prime/citation/42083694/When_Tuberculosis_Bleeds:_Intestinal_Tuberculosis_Presenting_With_Hematochezia.
DB - PRIME
DP - Unbound Medicine
ER -
