Disseminated tuberculosis presenting as a refractory perianal abscess in a Crohn’s disease patient: A case report

Disseminated tuberculosis (TB) is an important opportunistic infection in patients with Crohn’s disease receiving immunosuppressive therapy, where its manifestations may mimic inflammatory or infectious Crohn’s complications. Case: We describe a 40-year-old man with Crohn’s disease on azathioprine who presented with a recurrent perianal abscess unresponsive to antibiotics. CT revealed multiple hepatic and splenic micronodules with mild rim enhancement , in addition to randomly distributed pulmonary micronodules and small nodules , raising suspicion for disseminated TB. CT-guided aspiration of the perianal collection confirmed Mycobacterium tuberculosis on GeneXpert MTB/RIF. This case emphasizes that disseminated TB should be considered in immunosuppressed Crohn’s patients presenting with atypical or refractory perianal collections, and highlights key radiologic features that help differentiate TB from Crohn’s-related complications.