Diagnosing peritoneal tuberculosis

Abstract

Peritoneal tuberculosis (TB) is one of the most challenging forms of extrapulmonary tuberculosis to diagnose. This challenge can be compounded in low incidence regions, and in patients with cirrhosis in whom the presence of ascites alone may not prompt further investigation. A delay in the diagnosis and treatment of peritoneal tuberculosis may lead to worse clinical outcomes. This case describes a 64-year-old Italian male with decompensated cirrhosis being evaluated for liver transplantation, who developed abdominal pain and a persistent inflammatory ascites with peritoneal thickening despite antibiotic therapy. Peritoneal tuberculosis was suspected, although non-invasive and invasive direct mycobacterial testing remained negative. A constellation of positive QuantiFERON-TB Gold In-Tube test, elevated ascitic adenosine deaminase and dramatic symptomatic and radiographic response to empiric anti-tuberculous therapy confirmed the diagnosis of peritoneal tuberculosis. This paper will review the approach to the diagnosis of peritoneal tuberculosis.

A Case of White Peritoneal Nodules and Ascites

“…Persistence of symptoms after a course of antibiotics should prompt an evaluation for other causes of peritonitis (eg, gastrointestinal perforation), resistant pathogenesis, malignancy, and atypical infections. 3 Malignancy, such as carcinomatosis or ovarian cancer, is also a significant concern. Granulomatous peritonitis can be caused by starch peritonitis from surgical gloves, peritoneal sarcoid, and nontuberculous mycobacterial peritonitis for dialysis patients.…”

“…In patients presenting with ascites and abdominal pain or fever, spontaneous bacterial peritonitis is usually suspected first. Persistence of symptoms after a course of antibiotics should prompt an evaluation for other causes of peritonitis (eg, gastrointestinal perforation), resistant pathogenesis, malignancy, and atypical infections 3 . Malignancy, such as carcinomatosis or ovarian cancer, is also a significant concern.…”

Peritoneal Tuberculosis Mimicking Ovarian Cancer: Gynecologic Ultrasound Evaluation with Histopathological Confirmation

“…TB may reach the peritoneum hematogenously through the lymphatic system by the ingestion of contaminated sputum from pulmonary TB, contaminated food (especially unpasteurized dairy in the case of Mycobacterium bovis), or through direct extension from adjacent foci of infection [8,9]. All those conditions compromise the immune system, such as liver disease and alcoholic liver disease, as well as HIV infection, peritoneal dialysis, and neoplasms [10,11]. The most common ultrasonographic and CT findings in patients with TBP are ascites with or without septations, peritoneal thickening, mesenteric and omental involvement, thickened ileal valve and bowel, mesenteric adhesions, and lymphadenopathy.…”

Tuberculose péritonéale

“…Quatre-vingts pour cent des personnes qui souffrent de TB ont une atteinte pulmonaire; la TB péritonéale isolée ne s'observe que dans 1 % des cas 2,3 . Le diagnostic est complexe, car la coloration des bacilles acido-résistants et la culture mycobactérienne de l'ascite peuvent avoir des sensibilités d'aussi peu que 3 % et 20 % ou moins, respectivement [4][5][6] . La culture des spécimens de biopsie péritonéale pour recherche de mycobactéries est l'épreuve diagnostique standard.…”