Recurrent intestinal tuberculosis presenting as a small bowel cold abscess with partial obstruction: a case report

Background. Recurrent intestinal tuberculosis (RITB) is an uncommon manifestation of extrapulmonary tuberculosis and may occur years after completion of anti-tuberculosis therapy. Diagnosis remains challenging because clinical and radiological features are often nonspecific and may mimic other intra-abdominal conditions such as malignancy or inflammatory bowel disease. Case report. A 29-year-old male with a history of intestinal tuberculosis treated four years earlier presented with progressive abdominal distension, abdominal pain, anorexia, and vomiting. Physical examination revealed ascites without a palpable mass. Laboratory findings showed leukocytosis, anemia, hypoalbuminemia, and transient renal impairment. Imaging demonstrated partial intestinal obstruction with a mass-like inflammatory lesion and cold abscess formation. Ascitic fluid analysis showed markedly elevated adenosine deaminase levels. Stool Xpert MTB/RIF detected Mycobacterium tuberculosis with rifampicin sensitivity, and histopathology confirmed caseating granulomatous inflammation. Anti-tuberculosis therapy was reinitiated, with clinical improvement. Conclusion. This case highlights a rare delayed recurrence of intestinal tuberculosis presenting as a mass-like small bowel lesion with cold abscess formation. Integrated diagnostic approaches, including ascitic ADA, molecular testing, imaging, and histopathology, are essential in recurrent and paucibacillary disease.