A young man with abdominal pain and vomiting was diagnosed as having tropical sprue when partial villous atrophy was found on duodenal biopsy. After continuing ill-health for a year, tuberculosis was recognised and treated, and he is now well. Tuberculosis and the upper gastrointestinal tract can occur without evidence of TB elsewhere, and the causes of unexplained partial intestinal villous atrophy should include TB, especially in countries where this disease is common
