Objectives: To illustrate the two closely-related challenging disease entities and the deleterious impacts of disseminated tuberculosis, together with some important literature reviews regarding the diagnosis and its sequelae.

Case: Patient is a 22-year-old male with initial presentation of chronic diarrhea and constitutional symptoms, diagnosed as intestinal Crohn’s disease. Symptoms persisted despite starting him on immunosuppressive agent (mesalazine 2.0g once daily) during the second presentation. At the same time, chronic cough was reported. Physical examination showed bibasal crepitations with expiratory rhonchi on lung examination, with unremarkable abdominal examination. Investigations revealed normocytic normochromic anemia with raised inflammatory markers (C-reactive protein 13.12 mg/L, erythrocyte sedimentation rate 63 mm/hour) and coagulopathy. Subsequent chest and abdominal radiography were suggestive of a possibility of disseminated tuberculosis involving lung and bowel. His condition deteriorated rapidly despite starting on anti-tuberculous agents and the patient expired due to refractory respiratory failure from acute respiratory distress syndrome.

Conclusion: Diagnosing and differentiating inflammatory bowel disease with bowel tuberculosis could be challenging. Let us always bear in mind about this constant threat of tuberculosis with combination and vigilant approaches to any presentations. The aims are to clinch the diagnosis early and to treat this communicable disease promptly.

Keywords: tuberculosis, Crohn’s disease, immunosuppressive agent, ventilation

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