Recurrent Abdominal Wall Abscess as an Atypical Presentation of Peritoneal Tuberculosis: A Case Report

Peritoneal tuberculosis (TB) is an uncommon yet important form of extrapulmonary TB, often presenting a diagnostic challenge due to its nonspecific symptoms and diverse clinical manifestations. We report the case of a 38-year-old woman with type 2 diabetes mellitus, hypertension, chronic kidney disease, and a history of peritoneal dialysis, who presented with recurrent abdominal pain, fever, night sweats, and seropurulent discharge following prior abscess drainage. Despite empirical antibiotic therapy, her symptoms persisted. Imaging revealed intra-abdominal fluid collections and pneumoperitoneum, raising suspicion of intestinal perforation. Surgical exploration revealed a frozen abdomen with multiple cold abscesses, dense fibrous adhesions, and tubo-ovarian involvement. Histopathological examination confirmed peritoneal TB, showing caseous necrosis and Langhans giant cells. This case underscores the diagnostic complexity of tuberculous peritonitis, particularly in patients with a history of peritoneal dialysis and risk factors associated with endemic exposure to TB. Due to its overlap with intra-abdominal malignancies and other chronic infections, a high index of suspicion, histopathological confirmation - often via laparoscopy - and early initiation of anti-tuberculous therapy are critical for effective management and improved outcomes.