Progressive Wasting Syndrome with Pulmonary and Gastrointestinal Findings Suggestive of Malignancy

Background: Progressive wasting syndrome accompanied by pulmonary and gastrointestinal (GI) involvement often raises clinical suspicion for malignancy. However, intestinal tuberculosis (ITB) remains a critical yet frequently overlooked differential diagnosis, particularly in endemic regions. Given the overlapping clinical, radiological, and endoscopic features between ITB and malignancies such as lymphoma or adenocarcinoma, misdiagnosis can lead to delayed treatment and worsened outcomes. Objective: This review aims to elucidate the clinicopathological parallels and distinctions between ITB and malignancy-associated wasting syndromes, emphasizing diagnostic challenges, histopathological correlations, and modern imaging modalities. Methods: A systematic literature search was conducted across PubMed, Scopus, and Embase, focusing on studies comparing ITB with malignancies (2010–2024). Data on clinical presentation, biomarkers, radiological findings, and diagnostic algorithms were synthesized. Results: ITB frequently presents with constitutional symptoms (fever, night sweats, weight loss), chronic diarrhea, abdominal pain, and obstructive GI features. Radiological findings such as concentric bowel wall thickening, mesenteric lymphadenopathy with necrosis, and concomitant pulmonary lesions may mimic malignancy. Histopathological confirmation via caseating granulomas and PCR-based detection of Mycobacterium tuberculosis is diagnostic. Conclusion: A high index of suspicion for ITB is essential in patients with progressive wasting and GI manifestations, particularly in TB-endemic areas. Multidisciplinary integration of clinical, endoscopic, and molecular diagnostics can prevent unnecessary invasive interventions and optimize therapeutic outcomes.