ABSTRACT
Summary: Extrapulmonary tuberculosis (TB) is more common than pulmonary TB in immuno-suppressed renal transplant recipients. Atypical presentation of TB and disseminated TB is known in transplant recipients. Usually intestinal TB presents with pain abdomen, intermittent subacute intestinal obstruction, diarrhoea and/or constitutional symptoms like fever and weight loss. Here we report a case of renal allograft recipient on regular hospital follow up, presented with acute abdomen with no previous symptoms of fever, weight loss or abdominal symptoms and was diagnosed to have tubercular ileal perforation on exploratory laporatomy and confirmed by histopathological examination. This patient succumbed to the illness due to sepsis despite timely surgery, broad spectrum antibiotics and antitubercular therapy.