Tuberculosis Presenting as Intestinal Granulomas in a Patient from West Virginia

uberculosis (TB) is relatively uncommon in West Virginia compared to surrounding Appalachia and the rest of the country. Despite the low prevalence, it is essential to diagnose promptly given the high potential for significant disease burden. Miliary TB is a form of disseminated Mycobacterium tuberculosis infection resulting from hematogenous spread of the organism. Known risk factors for developing disseminated TB include immunosup-pressant medications, human immunodeficiency virus infection, and extremes of age. We present a case in which a patient without identifiable risk factors for TB developed intestinal TB that had been misdiagnosed as Crohn's disease. Shortly after being started on immunosuppressant therapy for the presumed inflammatory bowel disease, the patient developed significant miliary TB