Tuberculosis (TB) remains an important cause of mortality and a severe morbidity in the world. Gastrointestinal tuberculosis (GITB) is an uncommon disease and an often-misdiagnosed clinical problem. The distinction between GITB and Crohn's disease (CD) is a diagnostic challenge because they present similar clinical, radiological, endoscopic and histologic features. The correct diagnosis in countries where TB is not endemic involves a high index of clinical suspicion (for instance, migrant population and immunosuppressed individuals) and is essential for a correct management and a good outcome. Here we present a case of intestinal tuberculosis initially diagnosed as CD, the patient after starting steroid therapy developed pulmonary involvement.