Tuberculosis, with its pulmonary and extrapulmonary localizations, is rapidly increasing in Italy. The authors describe a case of a primary colonic tuberculosis in a 52-year-old Caucasian man. At admission the patient reported a 6-month history of constipation, weight loss and abdominal pain. He had rectal bleeding in the last two weeks. Haematological tests and chest X-ray were negative. Colonoscopy showed a stricture in the proximal transverse colon and multiple ulcers in the ileocecal tract. Multiple biopsies and culture demonstrated tuberculosis. The patient underwent a right hemicolectomy after an episode of acute intestinal hemorrhage and received pharmacological treatment for nine months. After four years he is still free of disease.