Difficulty in diagnosing peritonitis caused by multidrug-resistant tuberculosis

Area of Science:

• Infectious Diseases
• Gastroenterology
• Radiology

Background:

• Tuberculous peritonitis is a significant diagnostic challenge, particularly in resource-limited settings.
• Conventional methods like ascites fluid culture for acid-fast bacilli (AFB) often yield low sensitivity.

Observation:

• A 47-year-old Nigerian man presented with symptoms suggestive of abdominal pathology: fever, abdominal distention, and weight loss.
• Computed tomography (CT) imaging demonstrated massive ascites and significant peritoneal thickening, raising suspicion for tuberculous peritonitis.

Findings:

• Ascites fluid culture for AFB was negative, highlighting the limitations of this diagnostic approach.
• Histological examination and culture of a peritoneal biopsy definitively diagnosed multidrug-resistant tuberculosis peritonitis.
• Peritoneal biopsy proved essential for confirming the diagnosis when ascites cultures were uninformative.

Implications:

• Peritoneal biopsy is a critical diagnostic tool for suspected tuberculous peritonitis, especially when ascites cultures are negative.
• Radiological findings on CT, such as peritoneal thickening, are valuable in prompting suspicion for this condition.
• Early and accurate diagnosis through biopsy is crucial for effective management of multidrug-resistant tuberculosis peritonitis.