A 19-year-old student with chronic abdominal pain: A case report

A 19-year-old male student presented with persistent left iliac fossa pain, abdominal bloating, and borborygmi for one month. Initial investigations, including blood tests and an abdominal CT scan, were unremarkable. Endoscopic evaluations revealed oesophageal candidiasis, gastritis, and colonic findings suggestive of terminal ileitis and colitis. Histological analysis confirmed chronic inflammation without definitive aetiology. The patient initially responded well to mesalamine but experienced symptom recurrence upon discontinuation. Subsequent severe abdominal pain prompted further evaluation, uncovering ileal wall thickening, right iliac fossa ascites, and left-sided nodular pleural thickening with 7th rib lysis. Differential diagnoses included pleural mesothelioma and small bowel malignancy. However, a presumptive anti-tuberculosis (TB) treatment regimen led to complete symptomatic resolution and radiological improvement. This case underscores the diagnostic challenges of abdominal TB, particularly its ability to mimic inflammatory bowel disease and malignancies. It highlights the importance of a structured, multidisciplinary approach in TB-endemic regions when faced with persistent, unexplained gastrointestinal symptoms.