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Introduction: One-third of the world's population is infected with tuberculosis (TB), with intestinal TB representing the sixth most common presentation of extrapulmonary TB. The diagnosis of intestinal TB is a challenge for physicians due to its diverse clinical manifestations that mimic other infectious, autoimmune, and neoplastic disorders, and is thus rarely considered as the causative agent of disease., Presentation of Case: We present a 55-year-old male with no relevant familial history, who presented due to a loss of 10kg of weight in 2 months accompanied by nocturnal diaphoresis and continuous abdominal distension., Discussion: The incidence and the severity of intestinal TB are increased in immunosuppressed patients and more rapidly progress due to deficient immune response. However, our immunocompetent had severe progression resulting in surgery less than a month after the diagnosis was made., Conclusion: While the diagnosis of intestinal TB, and specifically colonic TB, is difficult and is almost never the first diagnosis entertained outside the immunocompromised population, we present a rare case in which the disease presents in an immunocompetent patient., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)