Intestinal Tuberculosis Mimicking Crohn’s Disease in a Young Woman Presenting with Small Bowel Obstruction: A Case Report

Introduction Intestinal tuberculosis (ITB) remains an important diagnostic challenge in gastroenterology because it frequently mimics Crohn’s disease clinically, radiologically, and endoscopically. Misdiagnosis may result in delayed treatment or inappropriate immunosuppression. Presentation with small bowel obstruction is uncommon and may prompt unnecessary surgical intervention. Case Presentation A 24-year-old woman with no significant medical history presented with colicky abdominal pain, bilious vomiting, abdominal distension, and constipation. Computed tomography demonstrated small bowel obstruction with a transition point at the distal jejunum/proximal ileum, associated with necrotic mesenteric lymphadenopathy, omental thickening, and free fluid. MRI enterography revealed terminal ileal inflammation, raising suspicion for Crohn’s disease. Fecal calprotectin was borderline elevated (120 µg/g). Further evaluation identified right upper lobe infiltrates on chest radiography and a positive interferon-gamma release assay. Bronchoscopy confirmed active tuberculosis by acid-fast bacilli smear and polymerase chain reaction. The patient was managed conservatively with nasogastric decompression and standard anti-tuberculosis therapy, leading to complete resolution of bowel obstruction without surgery. Conclusion This case highlights ITB as an essential differential diagnosis in patients with terminal ileitis or unexplained small bowel obstruction. Necrotic mesenteric lymphadenopathy and extraintestinal clues should prompt investigation for tuberculosis. Early multidisciplinary recognition may prevent unnecessary surgery and harmful immunosuppressive therapy.