Misdiagnosis of ileocecal tuberculosis—diagnostic dilemma with Crohn’s disease

Gastrointestinal (GI) tuberculosis (TB) accounts for 11% of all extra pulmonary TB and is the sixth commonest site for extra pulmonary disease. Possible mechanisms of spread into the GI tract include hematological, ingestion of contaminated milk or food, swallowing infected sputum in a patient with active pulmonary TB, contiguous transcoelomic spread. Ileocecal region is the most commonly affected site of GI TB and can present with obstruction, perforation, ileocecal mass. Free intestinal perforation as an initial manifestation of TB is very rare and commonly occurs in immunosuppressed patient. We present a case of TB manifesting as intestinal perforation in an immunocompetent patient without any prior clinical symptoms. This case highlights the need to consider TB as an important differential diagnosis in patients presenting with intestinal perforation particularly from endemic areas.