Non-healing gastro-duodenal ulcer: A rare presentation of primary abdominal tuberculosis

•This case has illustrated the difficulty of promptly diagnosing an unusual case of primary duodenal tuberculosis from chronic peptic ulcer disease, in the absence of pulmonary involvement in an immunocompetent patient.•A high index of clinical suspicion with a multidisciplinary team approach is required.•The first line of treatment for gastrointestinal tuberculosis is medical treatment, indicating that 6 months of an anti-tuberculosis regime is satisfactory. Surgical treatment should be sought for patients who develop complications such as obstruction, perforation, and stricture formation.•In the absence of positive pathological (polymerase chain reaction or acid-fast bacilli staining) and radiologic tests, the diagnosis is often established by obtaining a surgical histopathology specimen.

INTRODUCTIONWe present a case of primary gastrointestinal tuberculosis that has culminated in ulcer formation, in the absence of pulmonary involvement in an immunocompetent patient.PRESENTATION OF CASEA 28-year-old Asian male presented to casualty with a 1-week history of epigastric cramping abdominal pain and several episodes of non-bilious vomiting. The patient deteriorated clinically, becoming more cachectic and given his unexplained weight loss, an oesophageal-gastro-duodenal endoscopic imaging confirmed a duodenal ulcer. The biopsy of the non-healing ulcer was the hallmark of the disease, revealing evidence of granulomatous inflammation consistent with tuberculosis bacilli.DISCUSSIONGastrointestinal tuberculosis with ulceration is rare with respect to the oesophagus, stomach and duodenum. This case proves to be unique, as our patient had experienced primary isolated gastric tuberculosis in the absence of pulmonary tuberculosis in a healthy individual. Immunohistochemical staining, histopathology and radiological investigations have demonstrated their importance in confirming abdominal tuberculosis and the extent of bowel involvement.CONCLUSIONThis case has illustrated the difficulties associated with a prompt diagnosis of an unusual case of primary duodenal tuberculosis from chronic peptic ulcer disease in an immunocompetent patient.