✅ Correct Answer: C – Gastrointestinal tuberculosis

Correct Answer: C – Gastrointestinal tuberculosis

Why C is Correct:

Gastrointestinal tuberculosis (GI TB) is a common extrapulmonary manifestation of TB in endemic regions, including Cameroon. It typically affects the ileocecal region, due to abundant lymphoid tissue and stasis, and presents with:

• Wall thickening

• Loculated or free ascites

• Lymphadenopathy

• Constitutional symptoms (e.g., weight loss, night sweats)

The patient’s geographic origin, systemic symptoms, age, and characteristic imaging strongly support this diagnosis. TB is also known to mimic other gastrointestinal disorders but ascites, especially when loculated, and omental thickening are more suggestive of TB than other mimics.

Why the Other Options Are Incorrect:

• A) Crohn’s disease
  → While Crohn’s can affect the ileocecal region, it is uncommon in native African populations and rarely presents with loculated ascites or omental thickening. The systemic symptoms here — especially night sweats and significant weight loss — are more characteristic of TB than Crohn’s.

• B) Ileocecal carcinoma
  → Carcinoma typically occurs in older adults and usually presents as a focal mass rather than widespread wall thickening with ascites. Night sweats and rapid weight loss in a young woman make this diagnosis less likely.

• D) Infectious colitis
  → Infectious colitis generally presents with acute diarrhea, diffuse colonic wall thickening, and fever. It does not usually cause loculated ascites or chronic systemic symptoms like weight loss and night sweats. Also, it tends to resolve more quickly than TB.

Teaching Point:

In patients from TB-endemic areas (such as Cameroon), gastrointestinal TB should be high on the differential when there is ileocecal wall thickening, ascites, and constitutional symptoms. It remains a global diagnostic challenge due to its ability to mimic Crohn’s, carcinoma, and infection, but epidemiologic context and imaging features can guide the diagnosis.