A50-53 A Bleeding Imposter: Intestinal Tuberculosis Presenting as Hemorrhagic Shock

Abstract Intestinal tuberculosis is a rare cause of gastrointestinal bleeding that can mimic inflammatory bowel disease or malignancy. Massive bleeding causing hemorrhagic shock is uncommon but life threatening and highlights the need to maintain a broad differential for an acute GI hemorrhage. We present a case of a 36 year old male patient from Ecuador. He had prior GI malignancy resection, mesenteric lymphadenopathy and thrombocytosis. The patient presented to the ICU with complaints of intermittent hematochezia, nausea, vomiting, weight loss for 3 months. On presentation, he was ill appearing, tachycardic and hypotensive. Hemodynamics instability persisted despite aggressive IV fluid administration. Remarkable labs included anemia with a Hgb of 5.6 (baseline around 11) and a moderate lactic acidosis of 5.7 u/L. His presentation was consistent with hemorrhagic shock secondary to lower GI bleed. Two Vasopressors were initiated via a central line. CT of the abdomen and pelvis showed colonic thickening from cecum to splenic flexure. GI was consulted and colonoscopy with biopsy was performed along with epinephrine infusion adjacent to bleeding vessel. The results revealed acid-fast bacilli, confirming intestinal tuberculosis. He was initiated on standard quadruple therapy (Isoniazid, rifampin, pyrazinamide and ethambutol). Intestinal TB can cause mucosal ulceration and vascular erosion resulting in massive bleeding and shock. This case emphasizes the importance of maintaining a broad differential diagnosis for GI bleed including infectious etiologies. Early recognition and initiation of anti TB therapy are key to improving outcomes. This abstract is funded by: None