Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis.

BACKGROUNDS/AIMS: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. METHODS: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. RESULTS: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. CONCLUSIONS: The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

Tubercular liver abscess in immuno-competent patients.

We report two cases, the first one a 35 years old male, chronic alcoholic, and the other, a 15 years old boy, who presented to us with fever, Rt. hypochondrial pain, with USG-Abdomen revealing multiple liver abscesses in the first, and a single large abscess in the second. Both patients showed leucocytosis and, mildly deranged Liver Function Tests. Aspirated pus was sterile, and the patients did not show any clinical improvement despite broad spectrum antibiotics and amoebicides. Re-aspiration of pus after two weeks revealed the presence of Mycobacterium tuberculosis and both patients showed a dramatic improvement clinically after starting Anti-tubercular treatment. These cases are being reported because of the rarity of tubercular liver abscesses, and the importance of suspecting mycobacterial infection in patients of liver abscess not responding to conventional treatment.