Peritoneal tuberculosis in an immunocompetent, unknown risk patient

Area of Science:

• Gastroenterology
• Infectious Diseases
• Abdominal Imaging

Background:

• Tuberculosis (TB) can affect various organs, with peritoneal TB being an uncommon but serious manifestation.
• Diagnosis of peritoneal TB is often challenging due to non-specific symptoms and negative initial fluid analyses.
• This case highlights the importance of considering TB in patients with unexplained ascites and lymphadenopathy.

Purpose of the Study:

• To report a case of peritoneal tuberculosis mimicking other abdominal pathologies.
• To emphasize the diagnostic utility of lymph node biopsy in challenging cases of ascites.
• To illustrate the successful management and clinical outcome of peritoneal tuberculosis.

Main Methods:

• Clinical presentation of a 36-year-old male with abdominal distention, night sweats, and weight loss.
• Diagnostic workup including imaging (CT scan), paracentesis, and exploratory laparoscopy with mesenteric lymph node biopsy.
• Histopathological examination and mycobacterial culture of lymph node tissue.

Main Results:

• CT scan revealed enlarged mesenteric and retroperitoneal lymph nodes with ascites and omental infiltration.
• Ascitic fluid analysis showed lymphocytic exudate, but AFB smear and culture were negative.
• Histopathology confirmed caseous granulomas, and lymph node culture identified Mycobacterium tuberculosis complex, establishing the diagnosis of peritoneal tuberculosis.

Conclusions:

• Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites, especially with lymphadenopathy.
• Excisional biopsy of affected lymph nodes is a valuable diagnostic tool when initial investigations are inconclusive.
• Prompt initiation of quadruple anti-TB therapy led to rapid clinical improvement and resolution of symptoms.