Objective：To report a case of isolated rectal tuberculosis（TB），and to made a literature review to improve the understanding of this rare condition. Methods：The data of clinical features，laboratory examinations，endoscopic manifestations，pathological charac－teristics，diagnosis and therapy of one patient with isolated rectal TB in our hospital were collected. Moreover，literature was summa－rized and compared. Results：The patient was hospitalized for abdominal pain，bloody purulent stool and emaciation. Endoscopy showed a huge isolated rectal ulcer. However，histopathologic biopsy found no caseating granuloma or acid-fast bacilli. Multiple acid-fast stool cultures and TB polymerase chain reaction（TB-PCR） assay were also negative. But the tuberculin purified protein derivative （TB-PPD） skin test was strongly positive. In addition，there was no evidence of parenteral tuberculosis infection. Moreover，after 3 months of diagnostic anti-TB treatment，the patient had a clinical remission. Endoscopy revealed the rectal lesion was much improved. The rectal ulcer was healed after a continuous anti-TB therapy of 15 months，no recurrence was occurred up to now. Conclusion：Iso－lated rectal TB is a rare disease without characteristic clinical，imaging and endoscopic features. The positive rates of caseating granu－loma or acid-fast bacilli found by histopathologic biopsy are rather low. However，TB-PPD test and diagnostic anti-TB treatmet are simple but effective strategies，which have important value for increasing the diagnosing rate of TB.