Gastrointestinal tract tuberculosis (GIT-TB) is a rare form of TB, but one that poses a serious challenge in diagnosis and management, particularly in the setting of severe immunosuppression. We present a case of intestinal TB in a 3-month-old immunosuppressed infant whose chief complaints were progressive abdominal distention and failure to thrive with features of intestinal obstruction with the diagnosis of GIT-TB confirmed on histology and culture. The resulting serious complications despite surgery included short bowel syndrome, enterocutaneous fistulae, and cholestasis, necessitating the use of total parenteral nutrition and a modified parenteral TB treatment regimen. During the two-month stay in hospital, irreversible liver failure and azotemia developed, with the patient eventually succumbing to these complications. This case highlights the importance of early recognition and treatment of GIT-TB to prevent adverse outcomes. Further, there is need to investigate for immunodeficiency in such presentations, particularly in young infants. The challenges encountered by the clinicians underscore the importance of the development of World Health Organization (WHO) guidelines on the specific management of GIT-TB.
