Tuberculous pleuroperitonitis

Abstract

An 83-year-old man was diagnosed with tuberculous pleuroperitonitis on a thoracoscopic pleural biopsy. It may be due to endogenous reactivation of the foci in the pleura and peritoneum. Thoracoscopy, which can be performed under local anesthesia, should be considered when both pleural effusion and ascites are present.

Keywords: ascites; pleural effusion; thoracoscopy; tuberculosis.

FIGURE 1

Chest radiograph shows the left pleural effusion and mild thickening of the minor fissure (A). Chest computed tomography (CT) reveals a calcified nodule in the upper lobe of the left lung and left pleural effusion (B, C). Abdominal CT reveals minor ascites, irregular thickening of the peritoneum, and thickened mesenteric soft tissue (D). Abdominal CT after 2 months of antituberculosis treatment reveals no ascites (E)

FIGURE 2

Thoracoscopy performed under local anesthesia shows multiple granular protruding lesions in the pleura (A, B). Pleural biopsy revealing epithelioid granulomatosis with multinucleated giant cells (arrows) (hematoxylin and eosin stain) (C). Although staining for Mycobacterium tuberculosis (TB) of the pleural tissue is negative, pleural tissue culture is positive for TB