Disseminated tuberculosis: Challenges in diagnosis

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.

Diagnostic Challenge of Peritoneal Tuberculosis: A Case Report

“…However, when there are no signs of liver disease, a comprehensive etiological investigation is required 4 . According to some studies, the first line for diagnostic definition is the analysis of the ascitic fluid through paracentesis [4][5][6][7][8][9][10][11] ,which corroborates the procedures developed in this case reported.…”

“…Previous studies have attempted to standardize which tests should be ordered. Cell count and serum ascites albumin gradient (SAAG) were considered as mandatory tests, and the others should be performed according to diagnostic suspicion [4][5][6][7][8][9][10][11] .In the presented case, the analysis of ascitic fluid revealed a leukocytic exudative pattern, with lymphocyte predominance. The diagnostic hypothesis was of peritoneal disease due tocarcinomatosis, considering the patient's history of bladder cancer.…”

“…Several studies have demonstrated the usefulness of ADA in peritoneal fluid for the diagnosis of peritoneal tuberculosis [5][6][7][8][9] .It can occur anywhere in the peritoneum, meso, or omentum, and its dissemination can be hematogenous, lymph node, gastrointestinal, tubal rupture, and more rarely, by BCG-therapy [9][10][11] . The clinical presentation is often nonspecific, with fever, abdominal pain, and weight loss being the most common symptoms 8 , as reported in the case.…”

“…The ascitic fluid puncture, especially when there are no signs of liver disease, is essential for this diagnostic distinction [5][6] . When the findings of fluid present some exudative pattern, an inflammatory peritoneal disease by infection or neoplastic etiology is the most probable cause [6][7][8] . Cases in which Bacillus Calmette-Guerin therapy (BCG therapy) is performed to treat bladder cancer, peritoneal tuberculosis, although rare, can be an adverse effect of this therapy [9][10][11] .…”