Pseudo-Tumoral Intestinal Tuberculosis: A New Case Report

Intestinal tuberculosis in its rare pseudotumoral form can mimic cancer or Crohn’s disease, creating a diagnostic challenge that delays appropriate management. Histology is often nonspecific, and polymerase chain reaction constitutes an essential diagnostic tool. The inappropriate initiation of immunosuppressive therapy may worsen the condition. Malabsorption of antituberculosis drugs should be considered in cases of therapeutic failure. We report the case of a 46-year-old man initially treated for Crohn's disease due to chronic abdominal pain, diarrhea, and ileocecal lesions. Abdominopelvic computed tomography scan showed thickening of the ileal loops, with the first colonoscopy revealing ileocecal ulcerations. Biopsies were suggestive of non-necrotizing granulomatous colitis. The patient received corticosteroids and immunosuppressive therapy without improvement. The persistence of symptoms led to a second colonoscopy, whose biopsies revealed a positive polymerase chain reaction for Mycobacterium tuberculosis, justifying the initiation of antituberculosis treatment. After two months of antituberculosis treatment without improvement, a new colonic evaluation revealed an ulcerated, budding, friable, and bleeding cecal mass, with another positive polymerase chain reaction for Mycobacterium tuberculosis, confirmed during subsequent endoscopic examinations. In the absence of resistance to antituberculosis drugs, therapeutic adjustment was undertaken, suspecting impaired drug absorption. This case highlights the importance of considering intestinal tuberculosis in the differential diagnosis of ileocecal masses. A multidisciplinary approach integrating clinical, histological, radiological, and molecular data is essential to avoid diagnostic and therapeutic errors.