A Malignant Masquerade: Ileocecal Tuberculosis Presenting as an Ulceroproliferative Colonic Mass in a Young Woman

Ileocaecal tuberculosis is the most common form of intestinal tuberculosis and can occasionally mimic colonic malignancy, resulting in diagnostic challenges. We report a case of a 32-year-old woman presenting with generalized fatigue, significant weight loss, and bilateral pedal edema. Laboratory investigations revealed severe macrocytic anemia with elevated inflammatory markers. Stool occult blood negative. Colonoscopy revealed an ulceroproliferative friable growth causing luminal narrowing. Whole-body positron emission tomography-computed tomography (PET-CT) demonstrated non-segmental circumferential thickening involving the terminal ileum, ileocaecal junction, cecum, ascending colon, and proximal transverse colon with surrounding fat stranding and adjacent lymphadenopathy. Histopathological examination showed granulomatous colitis with positivity for acid-fast bacilli (AFB). AFB Gene expert was sent, turned out to be positive, confirming intestinal tuberculosis. The patient was treated with weight-based anti-tubercular therapy and showed significant clinical improvement, with considerable weight gain and normalization of hemoglobin levels. This case highlights the importance of considering intestinal tuberculosis in the differential diagnosis of colonic masses, though its proliferative, particularly in tuberculosis-endemic regions like India.