A Rare Case of Disseminated Extrapulmonary Tuberculosis Diagnosed by Endoscopic Ultrasonography‐Guided Fine‐Needle Biopsy: A Case Report

ABSTRACT Abdominal tuberculosis (TB) is uncommon in Taiwan and frequently mimics malignancy or other infectious diseases due to nonspecific clinical manifestations, often leading to delayed diagnosis. We report a 72‐year‐old man who presented with fever, anorexia, weight loss, and epigastric discomfort. Esophagogastroduodenoscopy (EGD) revealed a subepithelial lesion (SEL) on the posterior wall of the upper gastric body. Contrast‐enhanced computed tomography (CE‐CT) demonstrated mass‐like lesions involving the liver and upper gastrointestinal tract with enlarged abdominal lymph nodes (LNs), raising concern for malignancy. Endoscopic ultrasound–guided fine‐needle biopsy (EUS‐FNB) was performed on the gastric wall, hepatic lesion, and enlarged LNs. Histopathology revealed necrotizing granulomatous inflammation in all specimens, and tuberculosis polymerase chain reaction (PCR) confirmed Mycobacterium tuberculosis infection. Anti‐tuberculosis therapy resulted in marked clinical improvement and significant radiologic regression. This case highlights a rare presentation of extrapulmonary tuberculosis (EPTB) involving multiple digestive organs and underscores the diagnostic value of endoscopic ultrasound–guided tissue acquisition (EUS‐TA).