Tuberculosis and persistent chylous ascites

A boy in late adolescence presented with fever, weight loss, mediastinal and retroperitoneal lymphadenopathy, and was diagnosed with extrapulmonary tuberculosis. His clinical course was complicated by drug-induced liver injury, a tubercular psoas abscess requiring percutaneous drainage. After this procedure he developed rapidly recurring chylous ascites requiring frequent large-volume paracentesis. Despite prolonged antitubercular therapy, ascites persisted. Magnetic resonance lymphangiography demonstrated leakage from retroperitoneal lymphatics into the right perinephric region together with non-opacification of the thoracic duct beyond the cisterna chyli, suggesting lymphatic obstruction secondary to healed tuberculous lymphadenitis. Conservative measures, including dietary modification and octreotide, were unsuccessful. The patient underwent intranodal lymphatic embolisation using a glue-lipiodol mixture, resulting in sustained resolution of ascites. This case highlights the complex lymphatic complications of tuberculosis and demonstrates the diagnostic and therapeutic value of advanced lymphatic imaging and embolisation in refractory chylous ascites.