Abdominal Tuberculosis in a Young Female Immigrant-"the Great Masquerader" in a Nonendemic Country-a Case Report and Literature Review

Abstract

Background: Tuberculosis (TB), primarily recognized as a pulmonary disease, can manifest in various extrapulmonary forms, with abdominal tuberculosis (ATB) being one of the most common. Abdominal tuberculosis is one of the diseases known as "the great imitator" - it can mimic the clinical presentation of various diseases that are more common, such as appendicitis, acute cholecystitis, colitis, and some malignant diseases such as colon or stomach neoplasms. Diagnosis of ATB is often delayed, especially if a clinician in a nonendemic country does not include ATB in the differential diagnosis. Given the rising migration of people from the endemic to the nonendemic countries, we believe it is mandatory to raise consciousness about this clinical entity, as well as to lower a threshold to include ATB in the differential diagnosis.

Objective: We present a case of a 31-year-old patient from Nepal, who was admitted through the emergency department of General Hospital Zabok, Croatia, with signs of acute abdomen, later successfully diagnosed and treated for ATB.

Case presentation: We also deliver a brief literature review, summarizing the epidemiology, clinical presentation, diagnostic and therapeutic algorithms for ATB. Migrations are inevitably changing the vaccination status and epidemiological risks of any host country.

Conclusion: Medical personnel should keep upgrading and revising their knowledge of the "usual suspects" whilst differentially diagnosing both immigrants and non-immigrants, in order to make timely and good quality diagnosis and treatment.

Keywords: abdominal tuberculosis; extrapulmonary tuberculosis; peritoneal tuberculosis.

Figure 1.. MSCT of abdomen showing diffuse free fluid, meteoristic colon with aero liquid levels in the right abdomen.

Figure 2.. Intraoperative finding: yellowy, dim fluid in the abdominal cavity with peritonitic impression of visceral peritoneum of small and large bowel, nodular deposits of parietal and visceral peritoneum measuring 1-8mm in diametar, and adhesions connecting the transverse colon with the anterior abdominal wall.