Severe Manifestation of Peritoneal Tuberculosis: Clinical Case Report

Aim: To describe the clinical manifestation and the diagnostic process of a patient with peritoneal tuberculosis as a clinical challenge in a tertiary referral center in a Latin American country. Case description: A 61-year-old male patient from the urban area of Cali consulted for edema in the lower limbs, ascites, hyporexia, weight loss, cachexia, thrombocytopenia, elevated transaminases, imaging of splenomegaly and pulmonary, hepatic, and peritoneum nodules. Initially, neoplasia was suspected, but the adenosine deaminase report and histopathology were consistent with the diagnosis of peritoneal tuberculosis. Conclusion: Peritoneal tuberculosis represents the sixth cause of extrapulmonary tuberculosis, after lymphatic, pleural, osteoarticular, genitourinary, and meningeal manifestations. Despite having surveillance systems, peritoneal tuberculosis is still considered the most challenging infectious disease to reach a definitive diagnosis. We present a case of disseminated tuberculosis in which invasion of the peritoneum was verified, for which tetraconjugate treatment was started; however, the patient showed an adverse hepatic reaction and died due to multisystem involvement of a pulmonary infectious complication.

Objetivo: describir la presentación clínica y el proceso diagnóstico de un paciente con tuberculosis peritoneal como reto clínico en un centro de alta complejidad de un país latinoamericano. Descripción del caso: un paciente masculino de 61 años procedente del área urbana de Cali consultó por edema en los miembros inferiores, ascitis, hiporexia, pérdida de peso, caquexia, trombocitopenia, elevación de transaminasas, imágenes de esplenomegalia y nódulos pulmonares, hepáticos y en el peritoneo. Inicialmente se sospechó neoplasia, pero el reporte de adenosina desaminasa y la histopatología fueron consistentes con el diagnóstico de tuberculosis peritoneal. Conclusión: la tuberculosis peritoneal representa la sexta causa de tuberculosis extrapulmonar, después de las manifestaciones linfáticas, pleurales, osteoarticulares, genitourinarias y meníngeas. A pesar de contar con sistemas de vigilancia, la tuberculosis peritoneal sigue siendo considerada como la enfermedad infecciosa más desafiante para llegar a un diagnóstico definitivo. Se presenta un caso de tuberculosis diseminada en el que se comprobó invasión del peritoneo, por lo que se inició un tratamiento tetraconjugado; sin embargo, presentó una reacción adversa hepática y falleció producto del compromiso multisistémico de una complicación infecciosa pulmonar.

Níveis ascíticos e soros de biomarcadores tumorais (CA 72-4, CA 19-9, CEA e CA 125) em discriminação de causa de ascites: um estudo prospectivo / Ascitic and serum levels of tumor biomarkers (ca 72-4, ca 19-9, cea and ca 125) in discrimination of cause of ascites: a prospective study

ABSTRACT Background: The role of ascitic and serum levels of various tumour biomarkers in the discrimination of cause of ascites is not well established. Objective: To evaluate the role of serum and ascitic levels of tumor biomarkers (CA 72-4, CA 19-9, CEA and CA 125) in discrimination of cause of ascites. Methods: A prospective study was conducted in consecutive patients presenting with ascites. Serum and ascitic levels of CA 19-9, CA 125, CA 72-4 and carcinoembryonic antigen (CEA) were determined at the presentation. The patients with cirrhotic ascites, tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC) were eventually included in analysis. Results: Of the 93 patients (58 males, mean age 47 years) included, the underlying cause was cirrhosis in 31, PC in 42 and peritoneal tuberculosis in 20. The best cutoff for discriminating benign and malignant ascites for serum CEA, CA 19-9 and CA 72-4 were 6.7 ng/mL, 108 IU/mL and 8.9 IU/mL, respectively. The best cutoff for discriminating benign and malignant ascites for ascitic CA 125, CEA, CA 19-9 and CA 72-4 were 623 IU/mL, 8.7 ng/mL, 33.2 IU/mL and 7 IU/mL, respectively. Conclusion: The performance of single biomarker for the prediction of underlying PC is low but a combination of serum CA 19-9 and CA 72-4 best predicted the presence of peritoneal carcinomatosis.

RESUMO Contexto: O papel dos níveis ascíticos e séricos de vários biomarcadores de tumores na discriminação da causa das ascites não está bem estabelecido. Objetivo: Avaliar o papel dos níveis séricos e ascíticos de biomarcadores tumorais (CA 72-4, CA 19-9, CEA e CA 125) na discriminação da causa das ascites. Métodos: Estudo prospectivo foi realizado em pacientes consecutivos que apresentaram ascite. Foram determinados níveis do soro e ascítico de CA 19-9, CA 125, CA 72-4 e antígeno carcinoembrínico (CEA). Os pacientes com ascites cirróticas, peritonite tuberculosa e carcinomatose peritoneal (CP) foram eventualmente incluídos na análise. Resultados: Dos 93 pacientes (58 homens, média de idade 47 anos) incluídos, a causa básica foi cirrose em 31, CP em 42 e tuberculose peritoneal em 20. O melhor corte para discriminação de ascites benignas e malignas para soro CEA, CA 19-9 e CA 72-4 foram 6,7 ng/mL, 108 UI/mL e 8,9 UI/mL, respectivamente. O melhor corte para discriminação de ascites benignas e malignas para CA 125 ascitico, CEA, CA 19-9 e CA 72-4 foram 623 UI/mL, 8,7 ng/mL, 33,2 UI/mL e 7 UI/mL, respectivamente. Conclusão: O desempenho do biomarcador único para a previsão do CP subjacente é baixo, mas uma combinação de soro CA 19-9 e CA 72-4 melhor previu a presença de carcinomatose peritoneal.

Tuberculosis pediátrica intestinal. Un caballo de Troya / Pediatric Intestinal Tuberculosis. A Trojan Horse

Resumen La tuberculosis (TB) intestinal y peritoneal es una enfermedad regional, crónica, específica, generalmente secundaria a TB pulmonar avanzada. Mayormente adopta la forma localizada en el tejido linfoide ileal. El diagnóstico puede sospecharse por los síntomas, los antecedentes del paciente y las pruebas de imagen, entre ellas radiografía de tórax, tomografía axial computarizada y ecografía. La confirmación precisa realizar una colonoscopia y toma de biopsia para demostración de granulomas caseificantes y del bacilo ácido-alcohol resistente. Presentamos un caso de un niño que consulto por absceso perianal y fístula, tratado como enfermedad intestinal inflamatoria y cuya radiografía de tórax motivó la sospecha y estudio de TB.

Abstract Intestinal and peritoneal tuberculosis (TB) is a regional, chronic, specific disease, generally secondary to advanced pulmonary TB. It is mostly localized at the ileal lymphoid tissue. The diagnosis may be suspected due to the symptoms, the patient's history, and imaging tests, such as chest x-ray, computerized axial tomography and echography. For confirmation, it is necessary to perform a colonoscopy and a biopsy sample to show caseating granulomas and the acid-alcohol resistant bacillus. We present the case of a child who consulted for a perianal abscess and fistula that were treated as inflammatory bowel disease, whose chest x-ray encouraged the suspicion and study of TB.

Tuberculosis peritoneal. Caso clínico diagnosticado por laparoscopia / Peritoneal tuberculosis. Use of laparoscopy in the diagnosis

RESUMEN Se presenta el caso de un paciente diabético de 55 años de edad internado en la sala de Medicina Interna del Hospital Pablo Arturo Suárez de Quito - Ecuador, que acude con un síndrome febril de 8 días de evolución que se prolongó durante la hospitalización a más de 35 días sin causa o foco aparente, a pesar del tratamiento antipirético, acompañado de dolor abdominal difuso, pérdida de peso (aproximadamente 8 kg en 3 meses) y ascitis. Se investigó las posibles etiologías, incluyendo pruebas de alta sensibilidad y especificidad para tuberculosis como (Cuantiferon GOLD Tb), adenosina deaminasa (ADA), que resultó falsa-negativa. El diagnóstico se confirmó mediante biopsia peritoneal de una muestra obtenida por laparoscopia exploratoria como último recurso diagnóstico. La tuberculosis peritoneal es una enfermedad que ocurre por la reactivación de los focos tuberculosos latentes en el peritoneo, debido a la diseminación hematógena, linfática o por contigüidad a un foco primario; más del 90% de los pacientes tienen ascitis en el momento de la presentación y un 10% presenta una fase "seca" más avanzada con un abdomen "pastoso" (es una forma de enfermedad fibroadhesiva).Palabras claves: tuberculosis peritoneal, ascitis, síndrome febril prolongado, biopsia peritoneal, falsos negativos en pruebas diagnósticas de tuberculosis

ABSTRACT The case of a diabetic patient of 55 years of age is presented in the internal medical room of Pablo Arturo Suarez Hospital of Quito - Ecuador, the same comes with a febril syndrome of 8 days of evolution that prolonged during the hospitalization to more of 35 days without cause or apparent focus despite the antipyretic treatment, accompanied by diffuse abdominal pain, weight loss and ascitis, where the possible etiologies were investigated, including tests of high sensitivity and specificity for tuberculosis as (quantiferon), resulting false negative, confirming the diagnosis through peritoneal biopsy of a sample obtained by exploratory laparoscopy as a last diagnostic resource. Peritoneal tuberculosis is a disease that occurs by the reactivation of latent tuberculosous focus in the peritoneum, established by hematogen, lymphatic or contiguous dissemination of a primary focus, where more than 90% of patients have ascitis at the time of presentation, and a 10% present a more advanced "dry" phase with a "pastoso" abdomen, representing a form of fibroadhesive disease.Keywords:peritoneal tuberculosis, ascites, prolonged febrile syndrome peritoneal biopsy, false negatives in diagnostic tests for tuberculosis.

Tuberculosis peritoneal / Peritoneal tuberculosis

Resumen Hoy día la tuberculosis peritoneal es una enfermedad sobrediagnosticada en muchas instancias de salud, no sólo nacionales, basta con observar en la bibliografía que esta situación sigue manifestándose. Además, esta enfermedad resulta ser de difícil diagnóstico cuando no se cuenta con el adecuado interrogatorio, así como con las adecuadas herramientas diagnósticas de gabinete y laboratorio, por lo que surge la necesidad de realizar el interrogatorio correcto ante cuadros no tan claros de la enfermedad que se esté tratando. No obstante, cabe resaltar que México es un país en el que aún siguen ocurriendo abundantes casos de tuberculosis, por lo que el diagnóstico oportuno mejora no sólo la supervivencia, sino la calidad de vida que estos pacientes llegan a tener posterior a su enfermedad.

Abstract Nowadays, peritoneal tuberculosis is an entity that has been overdiagnosed in many instances of health, not only in Mexico, it is sufficient to note in the literature that this situation is still manifest. In addition, this entity proves to be difficult to diagnose without proper interrogation, as well as adequate cabinet and laboratory diagnostic tools. Therefore, the need arises to carry out an adequate interrogation when the symptoms are clear about the entity treated. However, it should be noted that Mexico is a country in which there are still abundant cases of tuberculosis, so timely diagnosis improves not only the survival, but also the quality of life these patients come to have after their illness.

Síndrome de Meigs sincrónico con tuberculosis peritoneal. Reporte de caso / Meigs syndrome synchronous with a peritoneal tuberculosis. A case report

Resumen Antecedentes: La sospecha clínica de tuberculosis peritoneal debe coexistir en todo paciente con dolor abdominal de causa desconocida; sobre todo si se acompaña de fiebre, ascitis y distensión abdominal. Caso clínico: Paciente de 23 años, con ascitis, derrame pleural y una masa pélvica; concentración elevada de Ca- 125 (875 U/mL), y síntomas sugerentes de cáncer de ovario avanzado. Los estudios de laboratorio y gabinete sugirieron una tumoración proveniente del ovario izquierdo. En la laparotomía diagnóstica se encontraron lesiones compatibles con tuberculosis peritoneal, por lo que se obtuvo una biopsia de la lesión, con resultado positivo de la enfermedad. Se prescribió tratamiento antituberculoso y, posteriormente, se efectuó un nuevo procedimiento quirúrgico debido a la persistencia de la tumoración pélvica y datos de abdomen agudo, en la que se encontró un cistoadenofibroma. Luego de su extirpación la paciente se recuperó por completo. Conclusión: La tuberculosis peritoneal es una enfermedad poco frecuente e inespecífica, al igual que la manifestación de tumores ováricos, por lo que representan un reto diagnóstico.

Abstract Background: Clinical suspicion of peritoneal tuberculosis must coexist in all patients with abdominal pain of unknown cause; especially if accompanied by fever, ascites and abdominal distension. Clinical case: A 23- year-old patient with ascites and pleural effusion, pelvic mass, elevated Ca 125 (875 U/mL), symptoms suggestive of advanced ovarian cancer, laboratory and cabinet studies were conducted, finding that the tumor comes from the left ovary, a diagnostic laparotomy in which lesions suggestive of peritoneal tuberculosis were found, so biopsies were taken, upon finding the result of positive pathology, antituberculous treatment was given and then underwent surgical treatment again for persisting pelvic mass and acute abdomen data, finding a cystoadenofibroma, which when removed, eventually the patient recovered completely. Conclusion: Peritoneal tuberculosis is a rare and nonspecific disease, as is the manifestation of ovarian tumors, which is a diagnostic challenge.

Tuberculosis peritoneal simulando carcinoma de ovario / Peritoneal tuberculosis mimicking ovarian carcinoma

La tuberculosis peritoneal es una ubicación extrapulmonar común en mujeres, con características similares a neoplasias malignas ováricas avanzadas. Es difícil de diagnosticar debido a que produce ascitis masiva y crecimiento peritoneal marcado, similar a la carcinomatosis. Se necesitan estudios patológicos y cultivos bacterianos para confirmarlo, ya que no existen hallazgos clínicos, de laboratorio o radiológicos patognomónicos para la patología. El tratamiento temprano generalmente tiene un buen pronóstico. Se presenta un caso de tuberculosis peritoneal con la triada clásica (ascitis similar a carcinoma ovárico en etapas avanzadas, tumores abdominopélvicos y aumento de las concentraciones séricas de CA-125). La laparotomía mostró nódulos abdominales-peritoneales con inflamación granulomatosa. La paciente inició tratamiento y, durante el seguimiento, los síntomas al igual que las concentraciones de CA-125 normalizaron.

Peritoneal tuberculosis is a common extrapulmonary site in females, mimicking an advanced ovarian malignancy. It is difficult to diagnose because it may produce massive ascites, and a gross peritoneal appearance similar to carcinomatosis. It requires confirmation by pathological studies and bacterial cultures, as there are not pathognomonic clinical, laboratory or radiologic findings. Early treatment usually is associated to good prognosis. A case of peritoneal tuberculosis with the classic triad (advanced-stage ovarian carcinoma-like ascites, abdominopelvic tumors and elevated serum CA-125 levels) is presented. Laparotomy showed abdominal and peritoneal nodules reported as granulomatous inflammation on biopsy. Patient started treatment and, on follow-up, symptoms and CA-125 levels normalized.

Tuberculosis peritoneal simulando carcinomatosis peritoneal en paciente en hemodiálisis: Reporte de caso / A Case Report Peritoneal Tuberculosis Simulating Peritoneal Carcinomatosis in a Hemodialysis Patient

Se presenta el caso de un hombre de 69 años inmunosuprimido, con insuficiencia renal en hemodiálisis, con cuadro de dolor abdominal crónico y enfermedad diarreica aguda, que progresó a obstrucción intestinal, por lo que fue llevado a laparoscopia diagnóstica que reportó carcinomatosis peritoneal, pero cuyo diagnóstico histológico final fue tuberculosis peritoneal.

This is a case study of a 69 year old immunosuppressed man with renal failure who was on hemodialysis. He developed chronic abdominal pain and acute diarrhea that progressed to intestinal obstruction. Diagnostic laparoscopy reported peritoneal carcinomatosis, but histological diagnosis showed that it was peritoneal tuberculosis.

Tuberculosis peritoneal con presentación clínica como cáncer ovárico avanzado: revisión de la literatura / Peritoneal tuberculosis with clinical presentation as advanced ovarian cancer

Se presenta el caso de paciente con ascitis, masa pelviana y CA 125 elevado, sugerentes de cáncer ovárico avanzado. Se realizó laparoscopía que demostró lesiones compatibles con tuberculosis peritoneal. La biopsia laparoscópica de las lesiones demostró granulomas, por lo que no se realizó más cirugía y se inició tratamiento antituberculoso específico con buena respuesta clínica. Se revisa en la literatura tuberculosis peritoneal y su dificultad con el diagnóstico diferencial con cáncer de ovario avanzado.

It is presented the case of a patient with ascites, pelvic mass and elevated CA 125, all suggested of advanced ovarian cancer. It was made a laparoscopy that evidenced lesions of peritoneal tuberculosis. The laparoscopic biopsy of the lesions demostrated granulomas, for that there was no more surgery made and antituberculosis specific treatment was started, with good clinical response. It is revisited in the literature peritoneal tuberculosis and its difficult differential diagnoses with advanced ovarian cancer.

Peritoneal carcinomatosis mimicking a peritoneal tuberculosis

Symptoms of a peritoneal progression from ovarian cancer are nonspecific such as abdominal pain, abdominal distention and more. Many imaging studies and serum CA-125 help diagnosis. However, it is difficult to exclude the instances of the diffuse peritoneal diseases that mimic carcinomatosis. The elevated CA-125 level usually correlates with the peritoneal carcimatosis, but it is often found in other peritoneal diseases. Therefore, the pathologic confirmation is necessary because of other mimicking diseases. In our case, CA-125 levels were elevated. Abdominal computed tomography finding was suspected a peritoneal tuberculosis but the pathologic result was the peritoneal carcimatosis, eventually.

Tuberculose peritoneal: um diagnóstico diferencial no abdômen agudo: relato de caso / Peritoneal tuberculosis: a differential diagnosis in acute abdomen: case report

JUSTIFICATIVA E OBJETIVOS: O Amazonas é o estado com maior taxa de incidência de tuberculose (TB) no Brasil, com 82,7casos por 100.000 habitantes. O acometimento peritoneal é raro, com alta morbimortalidade, representando 0,1 a 0,7% de todos os casos. O objetivo deste estudo foi relatar um caso de abdômen agudo inflamatório secundário a TB peritoneal em paciente jovem imunocompetente. RELATO DO CASO: Paciente do sexo masculino, 33 anos, procedentede Manaus-AM, etilista, com história de TB familiar. Evoluindo há um mês com ascite, astenia, cefaleia, febre vespertina, sudorese noturna, perda ponderal de 10%. Deu entrada no pronto-socorro com dor abdominal suprapúbica e sinais clínicos de irritação peritoneal. Foi submetido à laparotomia exploradora, sendo encontradas diversas lesões nodulares, que foram biopsiadas. O estudo histopatológico revelou formações granulomatosas, necrose caseosa e bacilos álcool-ácidos resistentes, compatíveis com TB peritoneal. As sorologias para vírus da imunodeficiência humana e hepatites B e C foram negativas. CONCLUSÃO: A TB peritoneal é de difícil diagnóstico, devendo ser lembrada como um diagnóstico diferencial em paciente jovem, imunocompetente, com quadro de abdômen agudo inflamatório procedente de área epidemiológica de alta prevalência para TB.

BACKGROUND AND OBJECTIVES: The Amazon is the state with the highest incidence rate of tuberculosis (TB) in Brazil with 82.7 cases per 100,000 inhabitants. Peritoneal involvement is rare with high morbidity and mortality, accounting for 0.1% to 0.7% of all cases. The aim of this study was to report a case of acute abdomen secondary to inflammatory peritoneal TB in an immunocompetent young patient. CASE REPORT: Male patient, 33 years old, coming from Manaus, state of Amazonas, alcoholic, with family history of TB. One-month progression with ascites, asthenia, headache, afternoon fever, night sweats, weight loss of 10%. The patient was admitted to the ER with suprapubic abdominal pain and clinical signs of peritoneal irritation. He underwent exploratory laparotomy and several nodular lesions were found which were biopsied. Histopathological examination revealed granulomatous formation, caseous necrosis and acid-alcohol resistant bacilli consistent with peritoneal TB. Serology for human immunodeficiency virus and hepatitis B and C was negative. CONCLUSION: Peritoneal TB is difficult to diagnose and should be included as a differential diagnosis in young, immunocompetent patients coming from epidemiological area of high prevalence of TB with acute abdomen with signs of inflammation.

A Case of Tuberculous Peritonitis Developed during Chemotherapy for Tuberculous Pleurisy as Paradoxical Response / 대한소화기학회지

After the start of anti-tuberculous treatment, paradoxical worsening of tuberculous lesions has been described. However, abdominal tuberculosis as paradoxical response is relatively rare. This report describes the 26-year-old female who suffered from peritoneal tuberculosis while treating tuberculous pleurisy with anti-tuberculous medications. It was considered as paradoxical response, rather than treatment failure or else. She was successfully managed with continuing initial anti-tuberculous medications. When a patient on anti-tuberculous medications is presented with abdominal symptoms, the possibility of paradoxical response should be considered to avoid unnecessary tests and treatments, which may result in more suffering of the patient. Herein, we report a case of peritoneal tuberculosis as paradoxical response while treating tuberculous pleurisy.

Tuberculosis peritoneal: informe de siete casos / Peritoneal tuberculosis: report of seven cases

Introducción: La tuberculosis peritoneal es una entidad clínica con baja frecuencia de presentación y por mucho tiempo casi olvidada de la práctica clínica. Casos clínicos: Presentación y análisis de siete casos con diagnóstico de tuberculosis peritoneal, tratados en cuatro hospitales de la ciudad de Aguascalientes, en un periodo de cinco años, que presentaron las siguientes características: edad promedio de 47.5 ± 6.5 años; seis de ellos del sexo femenino y uno del masculino. Dos pacientes tenían el antecedente de tuberculosis pulmonar. Los datos clínicos más relevantes fueron dolor abdominal en seis, ascitis en cuatro y dolor abdominal en tres. El tiempo de evolución promedio de los síntomas fue de 5 ± 1.7 meses. Los hallazgos tomográficos identificados fueron tumor ovárico unilateral en cuatro y bilateral en dos, ascitis en cuatro y adenopatía retroperitoneal en uno. A los seis pacientes del sexo femenino se les encontró niveles elevados de CA125, con mediana de 419 U/ml (286 a 512 U/ml). Se sospechó neoplasia maligna en el preoperatorio en todos los casos, por lo que fueron operados en forma electiva. Se realizó laparotomía con biopsia en tres, laparotomía con salpingo-ooforectomía en dos y laparoscopia con biopsia en dos. Se sospechó tuberculosis peritoneal al momento de la cirugía en todos. El promedio de estancia hospitalaria fue de 2 ± 0.5 días. No se presentaron complicaciones ni muertes hospitalarias. Conclusiones: La tuberculosis peritoneal es una enfermedad rara que se presenta cada vez con mayor frecuencia. Debe considerarse el diagnóstico en pacientes jóvenes con tumor anexial, ascitis y elevación de CA125.

BACKGROUND: Peritoneal tuberculosis (TB) is a misdiagnosed clinical entity of low frequency. Due to its rarity, it requires a high index of suspicion in clinical practice. Its incidence has been increasing in recent years. CLINICAL CASES: We present and analyze seven cases of peritoneal TB diagnosed and treated at four hospitals in Aguascalientes, Mexico during a 5-year period. Mean age of the patients was 47.5 +/- 6.5 years. There were six females and one male. Two patients had a history of treated lung TB. The most frequent clinical data were abdominal pain (six patients), ascites (four patients), and abdominal tumor (three patients). Symptom duration prior to surgery was 5.0 +/- 1.7 months. Abdominopelvic CT examinations revealed unilateral ovarian tumor in four patients, bilateral ovarian tumor in two patients, ascites in four patients, and retroperitoneal adenopathy in one patient. All female patients had elevated serum CA-125 levels with a median of 419 U/ml (range: 286-512 U/ml). All patients had a preoperative diagnosis of malignant tumor. All surgical procedures were elective and consisted of laparotomy with biopsy in three patients, laparotomy with salpingo-oophorectomy in two patients, and laparoscopy with biopsy in two patients. Diagnosis of TB was suspected in all cases during surgery. Mean hospital stay was 2 +/- 0.5 days. There was no postoperative morbidity or mortality. CONCLUSIONS: Peritoneal TB is uncommon. Diagnoses should be considered in all patients with ascites, adnexal tumors and elevated serum CA-125 levels.

Absceso hepático tuberculoso en paciente con tuberculosis peritoneal

La tuberculosis es un grave problema de salud pública a nivel mundial; se ha observado en la actualidad un incremento de la enfermedad. No obstante la tuberculosis extrapulmonar de afectación peritoneal es poco frecuente así como la presencia de abscesos tuberculosos. El riesgo de infección se incrementa en parte debido a una serie de factores tales como: inmunosupresión, VIH, patología maligna, tratamiento con corticoesteroides, cirrosis, entre otros(1,2). Esta enfermedad presenta una gran similitud con diversos cuadros clínicos y dado su presentación clínica variada debe sospecharse ante todo paciente que se presente con dolor abdominal de etiología desconocida principalmente si se acompaña de fiebre, ascitis tabicada y distensión abdominal(1). Se presenta el caso de una paciente femenina de 46 años de edad, con antecedente de artritis reumatoide quien ingresa por presentar dolor abdominal, ictericia, fiebre, esplenomegalia, retención de azoados, planteándose leptospirosis en un principio, con evolución tórpida. Durante su hospitalización comienza a presentar ascitis que luego se tabica y posteriormente se evidencia LOE en lóbulo hepático izquierdo cuyo drenaje reporto BAR. En el estudio de líquido ascítico se determino GASA<1.1, con linfocitos en 98%, ADA: 59 U/L. Se inicia tratamiento con rifampicina, isoniacida, pirazinamida y ethambutol con evolución satisfactoria.

Tuberculosis is a serious public health problem worldwide, and lately a rise on the incidence of this disease has been observed. The clinical presentation of extra-pulmonary tuberculosis with peritoneal incidence is so rare and atypical as well as the presence of tubercular abscess. The risk of infection has increased mostly due to a series of different factors including: immunosuppression, HIV, malignancy pathology, corticosteroids usage, cirrhosis, among others. This anomaly shows big similitude with other clinical cases and because of its diverse clinical form it should be suspected on every patient presenting abdominal pain with unknown etiology specially if is accompanied with fever, ascites septum and abdominal distension. We are presenting a case of a 46 years old female, admitted with abdominal pain, icterus, persistent low-grade fever, splenomegaly, azoate retention and, history of rheumatoid arthritis. On examination, she was diagnosed with leptospirosis with torpid evolution. Later on, after admitted in the hospital she started to show signs of ascites becoming septum, subsequently manifested LOE in left hepatic lobule reporting BAR in parecentesis. Analysis of the fluid yielded GASA <1.1, lynphocites 98% ADA: 59 U/L. Treatment with rifampicin, isoniazid, pyrazinamide y ethambutol was started and a satisfactory output was obtained.

Two Cases of Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis on F-18 FDG PET/CT / 핵의학분자영상

F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET/CT) plays an important role in diagnosis of malignant tumors and adds to conventional imaging in the staging of pertoneal carcinomatosis. However, false positive cases resulting from benign disease such as tuberculosis may occur. We report two cases of peritoneal tuberculosis on F-18 FDG PET/CT which showed multiple hypermetabolic foci in the mesentery and peritoneum with increased serum cancer antigen 125 (CA 125). Subsequent F-18 FDG PET/CT showed a disappearance of pathologic uptake following treatment with anti-tuberculosis drugs.

Study the difference of clinical and laparoscopic features between peritoneal tuberculosis and peritoneal malignancy

Background: Peritoneal tuberculosis (PT) and peritoneal malignancy (PM) are the most frequent causes of exsudate ascitic fluid but the different diagnosis between the former and the latter is also difficult and elusive. Objective: To study the difference of clinical and laparoscopic features between PT and PM. Subjects and method: 76 patients with PT and 50 with PM were diagnosed by laparoscopy and peritoneal biopsy. Ascitic mycobacterium tuberculosis was detected by PCR analysis. Exsudate ascites was confirmed according to criteria of Light. Results and Conclusions: Average age of PT was younger than of PM (p < 0.001). The frequency of fever, pleural effusion in the patients with PT was higher than those in PM (p < 0.001 and 0.05). The anemia and abdominal tumefaction in those of PM was more frequent than in those of PT (p < 0.05 and 0.001). High protein ascitic fluid and numerous lymphocytes in the patients with PT was frequent than in those with PM (p < 0.05). Laparoscopic features: In those patients with PT the white "miliary nodules" or adhesions between abdominal wall was more frequent than in those with PM (p < 0,05) and in patients with PM omental thickening, tumor formation was more than in those with PT.

Peritoneal tuberculosis with gastric cancer: a case report / Tuberculosis peritoneal con cáncer gástrico: reporte de caso

This is a report of a case with both peritoneal tuberculosis and gastric cancer. Physicians should have a high index of suspicion of peritoneal tuberculosis if the patient is febrile with a past history of tuberculosis.

Este es el reporte de un caso con tuberculosis peritoneal y cáncer gástrico a la vez. Los médicos debáan tener un alto índice de sospecha de tuberculosis peritoneal si se trata de un paciente febril con antecedentes de tuberculosis.

Two cases of peritoneal tuberculosis mimicking ovarian carcinoma diagnosed with laparoscopy / 대한산부인과학회지

Peritoneal tuberculosis is a rare presentation of tuberculosis. The presenting signs and symptoms, imaging examinations and CA-125 status in peritoneal tuberculosis sometimes resemble that of ovarian cancer. Thus, the possibility of peritoneal tuberculosis should be considered in the differential diagnosis of ovarian carcinoma. We report two cases of peritoneal tuberculosis initially suspected as ovarian carcinoma but diagnosed as peritoneal tuberculosis with laparoscopy. Using diagnostic laparoscopy unnecessary laparotomy was avoided. We suggest that diagnostic laparoscopy can be helpful in differential diagnosis between peritoneal tuberculosis and ovarian carcinoma.

A Case of Abdominal Tuberclosis Mimicking Ovarian Cancer / 대한소아소화기영양학회지

We report the case of a girl with peritoneal tuberculosis (Tb) who presented with mimicking features of ovarian cancer including massive ascites, elevation of CA-125 and ovarian masses. These ovarian masses cannot be ruled out malingnacy with image study. Gram stain, acid-fast stain, bacteriological and mycological culture of centrifuged ascites cells were negative. Tumor markers revealed an elevated CA-125 level of 112 U/mL and adenosine deaminase level were significantly high with 118 U/L. Diagnostic laparoscopy was done. The histology of the peritoneum and the ovary showed multiple granulomatous nodules with epithelioid cells and multi-nucleated giant cells. And there were no evidence of malignancy. Furthermore acid-fast bacilli (AFB) was identified in this specimen. Peritoneal Tb was difficult to diagnosis in our patient because it mimicked ovarian cancer. And this is the first case of abdominal Tb mimicking ovarian cancer in children in Korea.

A Case of Peritoneal Tuberculosis with Elevated Serum CA 125 Level / 대한산부인과학회잡지

Peritoneal tuberculosis is a disease rarely seen nowadays. Its symptoms are easy fatigue, abdominal distension, intermittent abdominal pain and ascites. Its onset is insidious, which si-mulates symptoms of peritonitis or carcinomatosis. Peritoneal tuberculosis should be considered in the differential diagnosis when a Patient's symptoms and signs are ascites, ovarian tumor, vague abdominal pain and abdominal distension with high serum level of CA 125, an antigenic determinant of epithelial ovarian cancers. We have recently experienced a case of peritoneal tuberculosis with markedly elevated serum level of CA 125 in 54 year-old woman and report our case with a brief review of the literature.