Tuberculosis (TB) remains one of the leading causes of death globally. Although abdominal or peritoneal TB is a recognised site for extrapulmonary TB to manifest, the diagnosis is often delayed due to the non-specific nature of the presenting clinical features. We present the diagnostically challenging case of a 32-year-old patient with recurrent episodes of fever and a non-productive cough that was initially treated as community-acquired pneumonia with oral antibiotics. A computed tomography scan of the thorax was unrevealing, aside from a large volume of ascites within the partially imaged upper abdomen. The patient did not report any abdominal symptoms and the abdominal examination was unremarkable. Subsequently, a transvaginal ultrasound, a contrast-enhanced computed tomography scan of the abdomen and pelvis, and magnetic resonance imaging of the abdomen and pelvis confirmed a large volume of ascites in the absence of any definite aetiology. A peritoneal biopsy was required before the diagnosis of peritoneal TB was eventually confirmed. This case highlights the importance of considering peritoneal TB in patients presenting with treatment-resistant chest symptoms and persistent pyrexia of undetermined aetiology, even in the absence of abdominal signs and symptoms.
A horseshoe adrenal gland is a rare congenital anomaly found almost exclusively in neonates and infants based on autopsy studies. It is a term used to describe a solitary adrenal gland situated in the midline, posterior to the inferior vena cava and abdominal aorta. To date, in the literature, there have been very few cases documented in adults and they have also been reported to be associated with other co-existing intra-abdominal, vascular and vertebral congenital anomalies. We describe a rare case of an asymptomatic adult patient who was incidentally found to have a horseshoe adrenal gland as well as a Type 1 diastematomyelia.
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