Inaugural Ascites as Presentation of Disseminated Tuberculosis: A Case Report

Disseminated tuberculosis (TB) is a life-threatening disease that presents more frequently in immunosuppressed patients. Its diagnosis is challenging, due to nonspecific clinical presentation and variable sensitivity and specificity of microbiological testing. We report the case of a 75-year-old woman without any known immunosuppressive risk factors who presented with constitutional symptoms, de novo ascites and bilateral pleural effusion. Paracentesis revealed lymphocytic ascites with a low serum-ascites albumin gradient. Thoracocentesis showed lymphocytic exudate. Adenosine deaminase levels were high in ascitic and pleural fluids. A thorough work-up excluded neoplastic causes. After 28 days, a positive ascitic fluid cultural test was obtained, with the identification of Mycobacterium tuberculosis complex. No other microbiological isolates were obtained. Diagnosis of disseminated TB was made, and antituberculosis treatment was initiated. This case reinforces the need for a high index of suspicion and a structured approach to diagnose disseminated TB, especially in non-high-incidence settings and in patients without any known immunosuppression.