Peritoneal tuberculosis: the diagnostic challenge must not preclude treatment

Area of Science:

• Infectious Diseases
• Microbiology
• Gastroenterology

Background:

• Peritoneal tuberculosis (TB) is an uncommon extrapulmonary manifestation of Mycobacterium tuberculosis infection.
• It disproportionately affects individuals from high TB burden regions, necessitating clinical suspicion in travelers.
• The diagnosis of peritoneal TB presents significant clinical and microbiological challenges, often leading to delayed treatment and adverse prognoses.

Observation:

• A middle-aged woman presented with constitutional symptoms including fever, abdominal pain, vomiting, anorexia, and weight loss.
• Physical examination revealed decreased breath sounds and ascites. Blood tests showed elevated inflammatory markers and anemia.
• Imaging demonstrated ascites, peritoneal thickening, mesenteric fat densification, and a right pleural effusion.

Findings:

• Diagnostic procedures including paracentesis, thoracotomy, and laparoscopy were performed.
• Mycobacterium tuberculosis was eventually isolated from ascitic fluid after a 6-week incubation period.
• The patient received a 6-month course of anti-TB medication.

Implications:

• This case highlights the diagnostic difficulties associated with peritoneal TB.
• Prompt initiation of empiric treatment, even with delayed microbiological confirmation, can lead to favorable outcomes.
• Raising awareness among clinicians regarding peritoneal TB in at-risk populations is essential for early diagnosis and management.