When Peritoneal Tuberculosis Mimics Carcinomatosis: A Diagnostic Enigma

Area of Science:

• Infectious Diseases
• Gastroenterology
• Radiology

Background:

• Abdominal tuberculosis (TB) involves various organs, with peritoneal TB being particularly difficult to diagnose.
• It often arises from latent TB reactivation or spread from active pulmonary TB.
• Increasing global travel and migration contribute to TB diagnoses in non-endemic areas.

Purpose of the Study:

• To present a case of abdominal tuberculosis mimicking peritoneal carcinomatosis.
• To discuss the diagnostic challenges and clinical presentation of peritoneal TB.
• To underscore the importance of considering TB in differential diagnoses for abdominal pathologies.

Main Methods:

• Case report of a 25-year-old male with symptoms of abdominal pain and diarrhea.
• Diagnostic workup included computed tomography (CT) scans, interferon-gamma release assay, upper gastrointestinal endoscopy, and diagnostic laparoscopy.
• Pathological examination of surgical specimens confirmed the diagnosis.

Main Results:

• Initial CT scans suggested peritoneal carcinomatosis due to irregular ascites.
• Further investigations, including a positive interferon-gamma release assay and laparoscopy with pathological confirmation, revealed abdominal tuberculosis.
• Helicobacter pylori infection was also identified but was not the primary cause of the symptoms.

Conclusions:

• Abdominal TB can present insidiously and mimic other serious conditions like malignancy.
• Diagnostic laparoscopy is crucial for definitive diagnosis when imaging and initial tests are inconclusive.
• Increased awareness and consideration of TB are vital, especially with rising global migration and immunocompromised populations.