Peritoneal Tuberculosis Complicated by Abdominal Abscesses: Diagnostic Challenges and Clinical Insights From Two Cases

Peritoneal tuberculosis (PT) is a rare form of extrapulmonary Mycobacterium tuberculosis infection that may closely mimic Crohn's disease (CD) or intra-abdominal malignancy, leading to diagnostic delay, particularly in endemic areas. We report two illustrative cases complicated by localized abscess formation. The first case involved a 40-year-old woman presenting with chronic right lumbar pain. Computed tomography (CT) revealed a large right psoas abscess associated with circumferential thickening of the cecal base and terminal ileum, along with necrotic mesenteric and iliac lymphadenopathy. Colonoscopy showed ulcerative ileocolitis, and histology demonstrated chronic granulomatous inflammation suggestive of either tuberculosis or CD. CT-guided biopsy of the abscess wall was performed, and polymerase chain reaction testing for Mycobacterium tuberculosis was positive. Histopathology examination was consistent with tuberculosis. The patient responded well to anti-tuberculous therapy with complete radiological resolution. The second case concerned a 17-year-old male admitted with right iliac fossa pain, fever, weight loss, and night sweats. CT showed a right pelvic collection adjacent to the ileocecal junction with distal ileal and cecal thickening, initially suggesting CD. Colonoscopy revealed ulcerative ileitis with granulomatous inflammation. As radiological drainage was not feasible, laparoscopy was performed and showed a friable micronodular peritoneum with terminal ileitis. Peritoneal biopsies demonstrated non caseating granulomatous inflammation, consistent with peritoneal and ileocecal tuberculosis. These cases highlight that PT may present as localized abdominal or psoas abscesses and closely mimics CD. Early integration of imaging, endoscopy, tissue sampling, and microbiological or molecular testing is essential for prompt diagnosis and appropriate curative treatment.