Peritoneal Lymphomatosis Masquerading as Pyoperitoneum in a Teenage Boy

A 16-year-old boy presented with 1 month of fever, abdominal pain, and distension. The ascitic tap drained pus-like fluid, and ultrasonography showed diffuse thickening of the omentum and mesentery with echogenic ascites. A diagnosis of pyoperitoneum due to peritoneal tuberculosis with secondary infection was suspected, and antitubercular therapy was started elsewhere, but there was no improvement. Computed tomography of the abdomen revealed enhancing soft-tissue thickening in the retroperitoneum, extending into the mesentery and encasing the superior and inferior mesenteric vessels. The ascitic fluid appearance deceptively resembled pus, but further analysis revealed atypical lymphocytes. Omental and bone marrow biopsies confirmed Burkitt lymphoma. Awareness of this rare presentation is imperative for making a correct diagnosis.