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February 5, 1982

Fatal Rectal Bleeding due to Tuberculosis of the Cecum

JAMA. 1982;247(5):667-668. doi:10.1001/jama.1982.03320300071031

GROSS rectal bleeding is a rare presenting symptom of ileocecal tuberculosis, a disease that has become rare in the United States in recent years.1,2 This case was diagnosed as Crohn's disease ten years before the fatal episode described here.

Report of a Case  A 65-year-old woman was admitted to the hospital for evaluation of lower abdominal pain associated with distention, nausea, and vomiting of several months' duration. She had a history of ethanol abuse and intermittent small rectal bleeding. In 1970, she had abnormal serological findings and anemia. A barium enema examination disclosed a filling defect of the terminal ileum and cecum thought to be Crohn's disease. She refused laparotomy and received a course of penicillin for the abnormal serological findings.She was emaciated and had mild icterus, slight hepatomegaly, and ascites consistent with the known history of alcoholic cirrhosis.Laboratory studies revealed the following values: WBC count, 8,200/cu