Complicated and delayed diagnosis of tuberculous peritonitis

Peritoneal tuberculosis is very rare in European countries. However, its incidence is increasing due to the continued immigration of people from endemic areas affected by tuberculosis.

The authors report a case of tuberculous peritonitis in a 46-year-old male patient from North Africa. The presenting symptoms of the disease were hiccups, dyspepsia, anorexia, and weight loss. Physical examination revealed an abdominal distension that suggested the presence of ascites. Subsequent investigations of ultrasound and computed tomography of the abdomen revealed the presence of massive ascites. A diagnostic laparoscopy went on to highlight a macro micronodular degeneration of the peritoneum. Histological examination showed the presence of epithelioid granulomas with typical Langhans cells with areas of caseous necrosis. The diagnosis of tuberculous peritonitis was then made, and the ascites quickly disappeared in response to the anti-mycobacterial therapy. The patient remained free of symptoms after 6 months of clinical follow-up.

In this case the clinical diagnosis was complicated and delayed due to clinicians' suboptimal knowledge of and experience with this disease. This case demonstrates why laparoscopy with peritoneal biopsy should be the gold standard in any clinical suspicion.