Intestinal Tuberculosis as an Early Manifestation of Extrapulmonary Tuberculosis in Patients with HIV : A Case Report

Abstract

Intestinal tuberculosis as an early manifestation of extrapulmonary tuberculosis in patients with HIV infection is a rare condition but has a major impact on morbidity and mortality and often poses diagnostic challenges because the gastrointestinal symptoms are non-specific and resemble those of other diseases. This case report aims to describe the clinical presentation, diagnostic process, and management implications of intestinal tuberculosis as an early manifestation of TB–HIV coinfection, while emphasizing the importance of extrapulmonary tuberculosis screening in HIV patients. The method used was a descriptive case report of a 23-year-old male with main complaints of chronic abdominal pain, diarrhea, fever, weight loss, and lymphadenopathy, which was evaluated through anamnesis, physical examination, laboratory examination, imaging (ultrasound and abdominal CT scan), and Xpert MTB/RIF molecular examination, followed by a review of the narrative literature related to the TB–HIV relationship and EPTB screening strategy. The patient was eventually diagnosed with HIV co-infection, active pulmonary tuberculosis, intestinal tuberculosis, mesenteric lymphadenitis, and suspected peritoneal tuberculosis and showed clinical improvement after administration of standard antituberculosis therapy integrated with initiation of antiretroviral therapy. This case concludes that intestinal tuberculosis can be an early sign of HIV infection and disseminated EPTB; hence, there is a need for a high level of suspicion, systematic EPTB screening, the use of appropriate diagnostic modalities, and the integration of TB–HIV services to enable early diagnosis, timely management, and improved clinical outcomes in patients with immunosuppression.