The CT image shows thickening and deformity of the cecum with a narrowed lumen (see figures). The image from the barium small bowel follow-through in this case shows some deformity of the cecum (see figures). One of the most common inflammatory processes of the ileocecal region is Crohn’s disease. It also can affect any portion of the gastrointestinal tract, and the colon is a likely area for further involvement. Possible infectious processes include amebiasis and tuberculosis. Both of these conditions can affect the ileocecal area and the rest of the colon. Of the possible neoplastic processes, the most likely is serosal metastasis, which has an affinity for the cecal region. Lymphoma must always be considered in the differential diagnosis of gastrointestinal lesions.

The final correct diagnosis for this patient was tuberculosis. When a chest radiograph was obtained, it was normal. A normal chest x-ray film should not preclude this diagnosis because intestinal tuberculosis can occur without an abnormal chest film, especially in patients with human immunodeficiency virus. Most intestinal tuberculosis occurs as a result of a patient with pulmonary tuberculosis swallowing infected sputum; intestinal tuberculosis is usually secondary. Although adenopathy may occur in patients with intestinal tuberculosis, it also occurs in patients with Crohn’s disease or lymphoma and does not help differentiate the conditions. Patients with these findings in the right lower quadrant are often misdiagnosed as having Crohn’s disease.