A case of encapsulating peritoneal sclerosis associated with tuberculous peritonitis

We report a case of encapsulating peritoneal sclerosis (EPS) associated with tuberculous peritonitis. A man in his 50s presented with fever, anorexia, and abdominal distension and was urgently hospitalized because computed tomography (CT) revealed ascites. Despite hospitalization for 1 month, the diagnosis remained unclear and his condition worsened; therefore, the patient was transferred to our hospital. At our hospital, his fever reached approximately 38 °C and an upper abdominal mass was palpable. Contrast-enhanced CT revealed encapsulated ascites and extensive peritoneal thickening with adhesions, resulting in a diagnosis of EPS. Mycobacterium tuberculosis complex was detected in the ascitic fluid culture, thus confirming EPS secondary to tuberculous peritonitis. CT revealed rapid bowel dilatation, suggesting a high risk of ileus. We initiated treatment comprising four antituberculosis drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol) and prednisolone (60 mg/day). The fever resolved rapidly and inflammatory markers improved. CT revealed resolution of ascites and bowel dilation. Therefore, the steroid dose was tapered. On day 28, the patient was discharged. This case highlights that tuberculosis should be considered as a cause of EPS in patients without a history of peritoneal dialysis, and that early steroid therapy is necessary to prevent EPS progression to ileus.