Sites affected include:
(1) small intestine
(2) ileocecal region
(3) colon
(4) anus
The onset can range from insidious to acute. The presentation may range from subclinical to severe. The infection may be limited or diffuse. Patients with mucosal ulcerations and/or diffuse disease tend to be more symptomatic.
Clinical findings may include:
(1) fever
(2) malaise
(3) vomiting
(4) lethargy
(5) sweating, especially at night
(6) anorexia and weight loss
(7) abdominal pain, which can be severe
(8) mesenteric lymphadenitis
(9) diarrhea with mucus, pus and/or blood (secondary to mucosal ulcerations)
(10) malabsorption
(11) gastrointestinal bleeding, which can be massive
(12) stagnant loop syndrome
(13) intestinal stenosis with bowel obstruction
(14) bowel perforation with or without fistula or peritonitis
(15) appendicitis
(16) palpable mass in the right lower quadrant or colon
(17) abdominal swelling with or without ascites
(18) anal fistula or fissure
People in whom the diagnosis should be suspected:
(1) history of tuberculosis
(2) immigrant or traveler from a country with endemic tuberculosis
(3) HIV-positive
(4) enteritis with ulcerations
Some reasons why the diagnosis may be missed:
(1) negative TB skin test
(2) absence of pulmonary tuberculosis
(3) failure to consider the diagnosis
(4) failure to culture for acid fast bacilli
(5) paucity of acid fast bacilli in sections
(6) misdiagnosed as Crohn's disease or cancer
(7) vague or nonspecific signs and symptoms
