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Tuberculous peritonitis developing during chemotherapy for pulmonary and intestinal tuberculosis: a case report
Kei Kasahara1, Atsuhiko Fukuoka, Koichi Murakawa
1Second Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan. kassan@naramed-u.ac.jp
Respirology (Carlton, Vic.)
|April 13, 2005
Summary
Tuberculous peritonitis developed in a patient undergoing treatment for pulmonary and intestinal tuberculosis. This rare case suggests a paradoxical response might explain the abdominal tuberculosis during chemotherapy.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Pulmonology
Background:
- A 54-year-old male patient was diagnosed with drug-susceptible pulmonary and intestinal tuberculosis.
- Treatment commenced with standard first-line antituberculous drugs: isoniazid, ethambutol, and rifampicin.
Observation:
- Approximately 5 months into therapy, the patient presented with significant ascites (abdominal fluid accumulation).
- A diagnostic laparoscopy revealed adhesions, leading to an accidental intestinal perforation during the procedure.
- Emergency surgery confirmed tuberculous peritonitis.
Findings:
- Tuberculous peritonitis developed despite active antituberculous chemotherapy.
- The patient had all-drug susceptible pulmonary and intestinal tuberculosis.
Implications:
- This case highlights the rare occurrence of abdominal tuberculosis during antituberculous treatment.
- A paradoxical immune response is hypothesized as a potential mechanism for this unusual presentation.
- Further investigation into paradoxical reactions in tuberculosis management is warranted.