Isolated gastric tuberculosis in an immunocompetent patient without pulmonary involvement

Gastric tuberculosis (TB) is rare and often overlooked, particularly in immunocompetent individuals, due to its non-specific symptoms. We report a case of a 57-year-old male with coronary artery disease who presented with epigastric pain, anorexia, and weight loss. Ultrasonography (USG) and contrast-enhanced computed tomography (CECT) revealed a necrotic mass near the gastroesophageal (GE) junction. Upper gastrointestinal endoscopy showed ulcerations at the fundus and GE junction. Biopsies taken during endoscopy revealed granulomatous inflammation with Langhans giant cells, consistent with TB. The patient was started on standard anti-tubercular therapy and is responding well to treatment. This case report is unique due to the rare presentation of isolated gastric tuberculosis in an immunocompetent patient without any pulmonary involvement, which was diagnosed through endoscopic biopsy and managed successfully with medical therapy. In conclusion, gastric TB, though uncommon, should be considered in patients with upper GI symptoms and abnormal endoscopic findings, even in the absence of pulmonary involvement. Early diagnosis through biopsy is essential to avoid misdiagnosis and unnecessary surgery. Clinicians, especially in TB-endemic areas, should maintain a high index of suspicion to ensure prompt and effective treatment.