TITLE:
Peritoneal Tuberculosis: Looking beyond the Typical Pathology
AUTHORS:
O’Dene Lewis, Suneel Tammana, Peter Sealy
KEYWORDS:
Peritoneal Tuberculosis; Tuberculosis; Tuberculosis Peritonitis
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.4 No.1,
March
7,
2014
ABSTRACT: Peritoneal tuberculosis (TbP), an uncommon peritoneal infection, is
commonly diagnosed in immigrants from developing countries and represents a
substantial proportion of cases of extra pulmonary tuberculosis. The
variability in patient presentation and the indolent nature of the infection,
combined with limited diagnostic strategies available for TbP, often results in
delayed diagnosis. Case: Described herein is the case of a 39 years old male recent immigrant from Mali (West Africa), with no significant
medical history that presented to hospital with a four-day history of abdominal pain and swelling. Examination was significant
for distended abdomen and shifting dullness. No signs and symptoms suggested
pulmonary infection, however, QuantiFERON-TB Gold and purified
protein derivative (PPD) test were positive suggesting latent Tb infection. In
the absence of pulmonary tuberculosis, a diagnosis of TbP should be established
histologically. Laparoscopic biopsy showed granuloma but the typical caseating
granuloma of TbP was not seen. Nonetheless, based on the extent of the clinical
and laboratory findings, the patient was diagnosed with TbP and anti Tb
treatment ensued with successful outcome. Conclusion: The lack of caseating
granulomas in the pathology should not rule out a diagnosis of TbP, especially
in cases where accompanying evidence suggests some form of Tuberculosis.