Pseudotomoral ileocecal tuberculosis mimicking a colon carcinoma in a hemodialysis patient

Extrapulmonary tuberculosis is more frequent in hemodialysis patients than in the general population but intestinal localization is an unusual present ation of this infectious disease. We report a 60 year old patient on regula r hemodialysis with intestinal tuberculosis masquerading as colon cancer. T he patient presented with rectal bleeding, abdominal pain and fever and the radiological findings were compatible with ileocecal carcinoma. After surgery histological examination showed non-caseating granulomas but mycobacterial culture was not available. We performed a colonoscopy and obt ained a biopsy of colonic mucosa for culture and other analyses. We identif ied acid-fast bacilli with Ziehl-Neelsen staining of formaldehyde preserved , paraffin-embedded tissue from the hemicolectomy and the colonic mucosal b iopsy. Treatment with isoniazid, rifampicin and pyrazinamide for nine month s was successful and well tolerated. Intestinal tuberculosis is a rare entity that we must keep in mind in a pat ient with abdominal pain, unexplained fever, digestive bleeding and particu larly with a positive tuberculin reaction. When culture is not possible we can obtain intestinal samples by colonoscopy and use appropriate staining o f paraffin-embedded tissues.