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Case Reports
. 2023 May 11:32:e01785.
doi: 10.1016/j.idcr.2023.e01785. eCollection 2023.

Peritoneal tuberculosis in an immunocompetent patient: A case report

Esteban Echeverri-Fernandez  1 , María A Amezquita  2 , Pablo Andrés Moncada  1   3 , Juliana Escobar  1   4 , Liliana Fernandez-Trujillo  1   5
Affiliations
Case Reports

Peritoneal tuberculosis in an immunocompetent patient: A case report

Esteban Echeverri-Fernandez et al. IDCases. .

Abstract

Introduction: Tuberculosis is endemic in Colombia, the prevalence of its pulmonary form in immunocompetent hosts is high, and peritoneal compromise instead is rare and difficult to diagnose.

Case presentation: A 24-year-old female patient living in a rural area presented to the emergency department with constitutional and gastrointestinal symptoms, including bloating, diarrhea, significant weight loss, nocturnal diaphoresis, and gradual onset of ascites with abdominal pain. Diagnostic workup, including paracentesis, a transvaginal ultrasound, and an abdominal CT scan, did not suggest malignancy or portal hypertension. However, diagnostic laparoscopy revealed a miliary pattern comprising the parietal and pelvic peritoneum, uterus, fallopian tubes, and major omentum suggestive of peritoneal tuberculosis. Anti-tuberculosis therapy was initiated with subsequent microbiological confirmation.

Conclusion: Abdominal compromise by tuberculosis is a diagnostic challenge, especially in patients with no apparent risk factors. The clinical manifestations and paraclinical data may be unspecific or inconclusive, requiring peritoneal biopsy and empirical treatment before definitive confirmation.

Keywords: Ascites; Ascitic fluid; Case report; Peritoneal tuberculosis; Tuberculosis; Tuberculosis-gastrointestinal.

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Conflict of interest statement

The authors declare that they have no competing interests. This manuscript has not been published and is not under consideration for publication elsewhere. Additionally, all authors have approved this paper's contents and agreed to the journal´s submission policies.

Figures

Fig. 1
Fig. 1
Abdominal scan showing irregular thickening of the parietal peritoneum (white arrow), there is also a significant amount of ascitic fluid.
Fig. 2
Fig. 2
The interior of the abdominal cavity can be seen during laparoscopy with parietal peritoneum in which innumerable micronodular lesions give the appearance of a miliary pattern (black circle).
Fig. 3
Fig. 3
A, B, C. H&E stain showing fibroconnective tissue with the presence of multiple granulomas with a crown of lymphocytes, epithelioid cells, and multinucleated giant cells, necrotic center. D, E, F. H&E staining at higher magnification shows chronic granulomatous inflammation, granulomas with necrosis, multinucleated cells, and epithelioid cells.
See this image and copyright information in PMC

References

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