An unusual case of ileocaecal tuberculosis in an 80-year-old Caucasian male

An 80-year-old Caucasian male presented with a seven-week history of diarrh oea and weight loss. Distal duodenal biopsies showed partial villous atroph y but he failed to respond to a gluten-free diet, Subsequently he developed a right iliac fossa mass associated with radiological evidence of ileocaec al ulceration. Colonoscopic biopsies from the caecum showed non-caseating g ranulomata and Ziehl-Neelsen (ZN) staining and culture for acid-fast bacill i (AFB) were negative. Crohn's disease was diagnosed and he was started on steroids. Although he showed an initial response, his condition then deteri orated and he died after six weeks. ZN staining of tissue at postmortem sho wed AFBs. Although a rare diagnosis in the UK, a high index of suspicion sh ould be maintained for ileocaecal TB in patients with appropriate clinical features, even if classical risk factors for TB are absent.