From Gut to Glomeruli: Multi-system Involvement in Tuberculosis

Tuberculosis (TB), caused by Mycobacterium tuberculosis , primarily affects the pulmonary system; however, extrapulmonary TB (EPTB) accounts for 15%–20% of cases and often presents significant diagnostic challenges, particularly in cases of multiorgan involvement. This report describes a rare case of EPTB affecting the stomach, kidney, and nasal septum, with clinical manifestations including crampy upper abdominal pain and significant weight loss. Despite negative microbiological tests, histopathological findings confirmed granulomatous inflammation, leading to the initiation of empirical. While there was no direct microbiological or histopathological evidence of TB involvement in the nasal septum and kidneys, the patient’s favorable response to ATT and the disappearance of fluorodeoxyglucose-avid lesions on positron emission tomography scan were considered indirect evidence of TB affecting these sites. The rarity of gastric TB, accounting for only 0.5%–2% of abdominal TB cases, often leads to misdiagnosis, as it mimics malignancies and other gastrointestinal disorders. The complexity of multisystem involvement in this case highlights the importance of early suspicion, multimodal diagnostics, and a multidisciplinary approach in managing atypical TB presentations. The patient demonstrated significant clinical and radiological improvement, reinforcing the role of timely recognition and tailored treatment strategies in achieving successful outcomes.