{
  "abstract": "A 72-year-old woman presented with a 2-year history of right lower abdominal pain and 2 months of intermittent abdominal distension. The patient denied symptoms such as fever, weight loss, night sweats, chronic cough, abnormal flatus or abnormal defecation. She also denied any history of tuberculosis, previous antituberculosis treatment (ATT) or known contact with patients with tuberculosis. She denied any history of non-steroidal anti-inflammatory drug use, gastrointestinal disorders, malignancy or relevant family history. Initial investigations at an outside hospital, including laboratory tests showing elevated inflammatory markers and an unremarkable abdominal ultrasound, led to a 7-day course of empirical antibiotic therapy with levofloxacin, but the patient showed no clinical improvement. The patient was then transferred to our hospital. The physical examination was unremarkable without tenderness or guarding. Laboratory tests revealed elevated erythrocyte sedimentation rate (ESR) of 58 mm/hour and C-reactive protein (CRP) of 12 mg/L, positive faecal occult blood, positive purified protein derivative of tuberculin with an induration diameter of 13 mm and positive T-spot test (Panel A: 204 spot-forming cell (SFC), Panel B: 384 SFC). There were no positive results in multiple stool aetiological cultures and stool acid-fast stains, other blood tests including complete blood count, liver and kidney function, pathogen screening, immune and tumour indicators (including carcinoembryonic antigen, carbohydrate antigen 19–9 and alpha-fetoprotein). Abdominal CT demonstrated thickening and heterogeneous enhancement of the ileocaecal junction and appendix with localised stenosis and proximal intestinal dilation ( figure 1A). Colonoscopy revealed nodular and uneven caecal mucosa, a swollen and narrowed ileocaecal valve with a smooth surface that could not be intubated into the terminal ileum and an unclear appendiceal opening (figure 1B). Mucosal biopsies from the caecum and ileocaecal valve showed chronic inflammation, with negative results of histological tuberculosis culture and acid-fast staining. Given the patient’s older age, absence of clinical obstruction, positive T-spot result and lack of histological evidence of malignancy and considering the relatively high incidence of tuberculosis (TB) in China,1 empirical ATT (isoniazid, rifapentine, ethambutol) was initiated for suspected intestinal TB (ITB) in combination with the patient’s own opinion against surgical exploration or repeated colonoscopy. During the 6-month follow-up, the patient experienced relief of abdominal pain and improvement of ESR and CRP levels. Repeated CT showed reduced enhancement and wall thickening in the ileocaecal junction and appendix, while the ileocaecal stenosis and proximal intestinal dilation remained unchanged (figure 1C). However, there still existed intermittent abdominal distension, and re-examination of colonoscopy revealed partial caecal mucosa improvement, though the ileocaecal valve appeared unaltered (figure 1D). Repeated multiple deep biopsies from caecal mucosa revealed poorly differentiated adenocarcinoma (figure 1E). Due to the pathological diagnosis of malignancy and persistent narrowing of the ileocaecal area, surgical intervention was undertaken.",
  "authors": [
    {
      "affiliations": [
        "Peking Union Medical College, Beijing, China"
      ],
      "name": "Hemiao Xu"
    },
    {
      "affiliations": [
        "Department of Pathology, Peking Union Medical College Hospital, Beijing, China"
      ],
      "name": "Zheng Wang"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China"
      ],
      "name": "Ziqi Guo"
    },
    {
      "affiliations": [
        "Peking Union Medical College, Beijing, China"
      ],
      "name": "Qiming Xiao"
    },
    {
      "affiliations": [
        "Department of Medical Records, Peking Union Medical College Hospital, Beijing, China"
      ],
      "name": "Xue Bai"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China"
      ],
      "name": "Kun He"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China"
      ],
      "name": "Weiyang Zheng"
    },
    {
      "affiliations": [
        "Department of Radiology, Peking Union Medical College Hospital, Beijing, China"
      ],
      "name": "Wei Liu"
    }
  ],
  "title": "New sights from an unexpected cause of ileocaecal lesions responding to antituberculous therapy",
  "uid": "2d7b00db-920b-598e-a67d-b02df4432f72"
}