DOI: https://doi.org/10.36347/sjmcr.2025.v13i10.083

Pages: 2533-2535

Gastrointestinal tuberculosis is a rare form of extrapulmonary tuberculosis, and involvement of the rectum and colon (recto colitis tuberculosis) is particularly uncommon. Its imaging features often overlap with inflammatory bowel disease, colorectal malignancy, or nonspecific infectious colitis, making radiologic evaluation crucial for early diagnosis. We report the case of a 36-year-old male who presented with a 3-month history of chronic diarrhea, intermittent rectal bleeding, tenesmus, and lower abdominal pain. Laboratory tests revealed mild anemia and elevated inflammatory markers. Computed tomography (CT) of the abdomen demonstrated regular thickening of the rectosigmoid wall with mucosal enhancement and surrounding fat stranding. No evidence of distant spread or lymphadenopathy was observed. Colonoscopy revealed multiple ulcerative and nodular lesions, and biopsies confirmed granulomatous inflammation with caseating necrosis. Ziehl-Neelsen staining was positive for acid-fast bacilli. The patient was treated with a standard 6-month anti-tubercular therapy regimen, resulting in complete clinical and radiologic resolution of the lesions. Recto colitis tuberculosis, though rare, should be considered in the differential diagnosis of chronic colitis with regular colonic wall thickening on imaging, especially in regions with high tuberculosis prevalence. Radiologic evaluation, combined with endoscopic and histopathologic correlation, is essential for timely diagnosis and management, allowing prompt initiation of anti-tubercular therapy and preventing complications.