# The hidden path of mycobacterium: a case series of rare and elusive manifestations of gastrointestinal tuberculosis

## TL;DR

This paper presents rare cases of gastrointestinal tuberculosis that mimic other conditions, highlighting the need for early diagnosis to avoid unnecessary treatments.

## Contribution

The study contributes four rare and underreported cases of gastrointestinal tuberculosis with unique clinical presentations.

## Key findings

- Hepatic tuberculosis can mimic intrahepatic cholestasis and requires biopsy for diagnosis.
- Isolated gastric and esophageal tuberculosis can present with nonspecific symptoms and require advanced diagnostic techniques.
- Duodenal tuberculosis can mimic gastric outlet obstruction and resolve with standard anti-tubercular therapy.

## Abstract

Extrapulmonary tuberculosis continues to challenge clinicians with its protean manifestations, particularly when involving the gastrointestinal tract. While ileocecal TB is well-characterized, isolated involvement of the liver, stomach, and esophagus, Duodenum remains exceptionally rare and diagnostically elusive. We describe four rare presentations of gastrointestinal tuberculosis from a tertiary care center in India. Case 1 involves hepatic tuberculosis mimicking intrahepatic cholestasis, diagnosed via liver biopsy and special staining. Case 2A details isolated gastric TB presenting with nonspecific dyspepsia, ultimately diagnosed through endoscopic ultrasound-guided FNAC. Case 2B describes esophageal tuberculosis with bronchoesophageal fistula-an exceedingly rare entity-confirmed radiologically and histologically. Case 2C describes a case of duodenal tuberculosis presenting as partial gastric outlet obstruction (GOO). All cases demonstrated clinical and radiological resolution following standard anti-tubercular therapy. These cases posit the diagnostic complexity of gastrointestinal TB when it involves uncommon sites. Heightened clinical suspicion and timely histopathological confirmation remain key to averting morbidity. Early recognition facilitates successful medical management and obviates unnecessary surgical interventions.