The clinical manifestations, radiological and endoscopic findings of colonic tuberculosis are non-specific. A diagnosis of colonic tuberculosis is usually difficult because the condition can mimic tumors. Fever occurs in 60~85% of patients with tuberculosis, which is one of the important signs of disease activity, and usually resolves by the second week after beginning treatment. However, there are some patients who remain febrile beyond a reasonable treatment period or develop fever during treatment. Such cases raise issues, such as cytokine release from tuberculous granuloma, drug induced fever, drug resistance, and drug malabsorption. We encountered a patient with polypoid colonic tuberculosis who presented with prolonged fever after commencing treatment and became defervescence after a colonoscopic polypectomy. We report this case with a review of the relevant literature.