Background: Tuberculosis (TB) colitis, an extrapulmonary manifestation of TB, presents a diagnostic challenge in the absence of pulmonary disease. This case study illuminates TB colitis, emphasizing its clinical characteristics, diagnostic methodologies, and management strategies. Aim: TB mimics other GI conditions including Crohn’. It is important to consider it as a differential especially in people coming from prone areas. Colonoscopy with deep biopsy proves valuable in obtaining tissue diagnosis, revealing characteristic ulcerative and hypertrophic lesions. Case Presentation: We report the case of a 36-year-old immigrant from India, initially presenting with rectal bleeding, subsequently agreeing to night sweats and substantial weight loss. A colonoscopy revealed Acid-fast bacilli (AFB)-positive granulomatous colitis, leading to microbiological confirmation. Conclusion: This case underscores the need for timely recognition and management to prevent morbidity associated with TB colitis, especially in cases with atypical presentations. Increased awareness among clinicians is crucial for improving diagnostic accuracy and ensuring prompt initiation of appropriate therapeutic measures.
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