Thinking Outside the Lungs: A Case of Disseminated Abdominal Tuberculosis

Bhandari, Binita; Snyder, Samantha; Goldman, John

doi:10.12659/ajcr.926194

Cited by 2 publications

(6 citation statements)

References 14 publications

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“…Peritoneal TB presents a diagnostic challenge because of its nonspecific clinical presentation, including abdominal pain and distension, fever, weight loss, nausea, and vomiting [1][2][3]. Consequently, time from the onset of infection to diagnosis can vary from weeks to months or years [6].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Definitive diagnosis of peritoneal TB involves a diagnostic paracentesis in patients with ascites [ 2 , 3 ]. A positive AFB smear and culture for Mycobacteria on the ascitic fluid establishes the diagnosis of PT [ 3 ]. However, the ascitic fluid AFB smear and cultures are often negative, and because of the slow AFB growth rate, it may take as long as 8 weeks for the culture to become positive [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the ascitic fluid AFB smear and cultures are often negative, and because of the slow AFB growth rate, it may take as long as 8 weeks for the culture to become positive [ 11 ]. Cell counts from the ascitic fluid analysis usually demonstrate a lymphocytic predominance [ 3 , 9 , 12 ]. The SAAG score on the ascitic fluid in patients with TB without cirrhosis usually is less than 1.1 [ 2 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another pathway of peritoneal infection is the direct spread of TB from an infected adjacent focus, such as the fallopian tubes [ 2 ]. Immunocompromised individuals, including patients with human immunodeficiency virus (HIV), cirrhosis, diabetes mellitus, malignancy treated with immunosuppressive agents, corticosteroids, and patients on continuous peritoneal hemodialysis, are at high risk for a variety of chronic granulomatous diseases, including TB [ 2 , 3 ]. Tuberculosis involving the peritoneal cavity is an uncommon presentation, however, and should be considered in any individual who presents with abdominal symptoms and who resides in an endemic area where the prevalence of TB is high.…”

Section: Introductionmentioning

confidence: 99%

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Peritoneal and Pulmonary Tuberculosis in a Postpartum Female with Elevated Cancer Antigen 125 and Ascites

Lavrynenko

Baireddy

Bodepudi

et al. 2022

Case Reports in Infectious Diseases

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Background. Peritoneal tuberculosis is a rare form of extrapulmonary tuberculosis and presents a challenging diagnosis because of its nonspecific clinical manifestations. Peritoneal TB mimics other pathologies, including abdominal carcinomatosis, especially when the patient presents with ascites and an elevated cancer antigen (CA)-125 levels. Case Presentation. A postpartum 20-year-old Hispanic female recently discharged after transverse cesarean surgery, presented to the ER with fever, chills, edema, abdominal distension, nausea, and vomiting. The patient was febrile, tachycardic, and hypotensive. Chest X-ray demonstrated alveolar and interstitial consolidations; chest CT revealed tree-in-bud opacities in the right lower lobe, suggestive of atypical (TB)/fungal infection. CT of the abdomen and pelvis demonstrated ascites, omental thickening, peritoneal thickening, and mesenteric adenopathy, suggestive of carcinomatosis. She was admitted with a presumed diagnosis of sepsis secondary to pneumonia and started empirically on broad-spectrum antibiotics without clinical improvement. A battery of oncology markers was ordered and revealed a mildly elevated cancer antigen (CA)-125. Diagnostic paracentesis showed lymphocytic predominance with positive mycobacteria PCR, elevated adenosine deaminase (ADA), and no malignant cells. Subsequently, the sputum acid-fast bacilli (AFB) stain returned positive for tuberculosis, confirming the diagnosis of pulmonary tuberculosis. A peritoneal biopsy was obtained and demonstrated caseating granulomas consistent with peritoneal tuberculosis. The patient was started on standard antituberculosis therapy with clinical improvement. Conclusions. This case highlights the need for a high-level of suspicion for peritoneal tuberculosis in a patient with pulmonary tuberculosis who presents with intra-abdominal ascites, omental thickening, peritoneal thickening, and mesenteric lymphadenopathy, despite the presence of an elevated CA-125 level.

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