ABSTRACTWe present the case report of a twenty one years old white male drug addict who complained in the Emergency Departement of fever, weight loss, abdominal pain and diarrhea. A first diagnosis of appendicitis was excluded. Based on radiologic and endoscopic studies a diagnosis of Crohn’s ileocecal disease was achieved and a treatment with 5-amino-salicilic acid and corticosteroid was started. There was a poor clinical response so 5-mercaptopurine was added. Six weeks later be became neutropenic and fever relapsed. The chest X- rays and computer tomogram (CT) revealed a right pleural effusion and a nodular cavitated lesion in the posterior segment of the upper right lung lobe. A pleural biopsy was performed and acid fast bacilii (AFB) were seen. Specific treatment for tuberculosis was started. The lung findings resolved but fever and abdominal pain persisted. After several diagnostic procedures a laparotomy was required. A terminal ileitis with a fistulous comunication to the sigmoid colon was confirmed and a partial colectomy was done. There was mesenteric lymph node enlargement and AFB ewere identified on biopsy material. The patient remains free of disease after 10 months.REV PORT PNEUMOL 1999; V (4): 427-434