Severe pulmonary tuberculosis complicating intestinal tuberculosis with the entire colorectal ulcers.

T remains a major global public health problem, particularly in developing countries.1 Intestinal tuberculosis can mimic any disease such as other infectious processes, neoplastic disorders, ulcerative colitis, and Crohn’s disease. The diagnosis of intestinal tuberculosis, and specifically colonic tuberculosis, is a challenge for physicians due to its clinical presentation is usually nonspecific. Intestinal tuberculosis of entire colorectal ulcers has been very rarely reported. Recently, we experienced a case of severe pulmonary tuberculosis complicating intestinal tuberculosis with the entire colorectal ulcers. The clinical features and the diagnostic problems of these rare forms of intestinal tuberculosis are presented. A 28-year-old woman presented with a 2-month history of intermittent hypogastric abdominal pain, and a 15 kg weight loss over 2 months. Further complaints included diarrhea, vomiting, cough, and fever. Her past medical history was unremarkable. Physical examination revealed several swollen mandibular lymph glands. On abdominal examination, the abdomen pain was located in the right lower quadrant. No palpable mass was in the abdomen. Laboratory test results as follows: white blood cell count 4.3×109/L; hemoglobin 89 g/L; and erythrocyte sedimentation rate 36 mm/h. Purified protein-derivative skin test and assay for human immunodeficiency virus (HIV) were negative. A chest radiograph revealed diffuse miliary nodular pattern in both lung fields (Figure 1A). Colonoscopy showed multiple superficial ulcers on entire colon and rectum (Figures 1B and 1C). Histologic analysis of mandibular lymph gland biopsy indicated a caseous necrotizing, granulomatous inflammation (Figure 1D). Histological findings of the colonic biopsy were inflammatory exudation and granulomas (Figure 1E). Antituberculous treatment resulted in dramatic clinical and endoscopic improvement. She responded well, and gained 10 kg weight at 6 months follow-up. Disseminated tuberculosis has a high mortality and in the meantime, its morbidity rate is still high in developing countries.2 Successful clinical outcomes of disseminated tuberculosis depend mainly on an early diagnosis and treatment. Clinical manifestations of disseminated Clinical Note