SHM Converge Scientific Abstract ePoster Gallery-I Can't Stomach This:how Peritoneal Tuberculosis Hides in Plain Sight

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This case highlights the diagnostic challenge of peritoneal tuberculosis (TB), a rare form of extrapulmonary TB that accounts for about 5% of EPTB cases. Because it often presents with vague, slowly progressive symptoms such as abdominal pain, ascites, fever, night sweats, weight loss, diarrhea, constipation, or abdominal distention, it can mimic other conditions like peritoneal carcinomatosis on CT imaging. Definitive diagnosis requires identification of Mycobacterium tuberculosis from ascitic fluid or biopsy.<br /><br />The patient was a 53-year-old Hispanic woman with a history of cervical cancer in remission, hypertension, and inflammatory arthritis treated with infliximab, placing her at increased risk for TB reactivation. She presented with several weeks of recurrent fevers, nausea, diarrhea, abdominal pain, and new ascites. She had previously been treated for presumed spontaneous bacterial peritonitis despite a negative infectious workup, but symptoms persisted. On admission, she was febrile and had a distended, diffusely tender abdomen with shifting dullness and bilateral leg edema.<br /><br />Initial labs showed leukocytosis, hyponatremia, low albumin, and elevated liver enzymes. CT imaging raised concern for malignancy because of ascites and omental caking. She was initially treated with ceftriaxone and metronidazole while malignancy and infection were investigated. Paracentesis later showed lymphocyte-predominant ascitic fluid, prompting airborne TB precautions and additional testing. Omental biopsy and stool studies ultimately confirmed TB: MTB PCR was positive, stool AFB smear was positive, and biopsy showed caseating granulomas with AFB and no malignancy. She was started on RIPE therapy and discharged improved.<br /><br />The key lesson is to suspect peritoneal TB in patients with ascites and constitutional symptoms, especially when epidemiologic risk factors or immunosuppression are present.

Asset Subtitle

Dorothy Han

Meta Tag

Author List Alan David, Ariel Lee, Dorothy Han, Nausheen Wakhlu, Shadi Dowlatshahi, Zina Ahmed

Category Clinical Vignettes

Concept Extrapulmonary Tuberculosis

Concept Dry Adhesive Tuberculous Peritonitis

Concept Cirrhotic Ascites

Concept RIPE Therapy

Concept Latent Tuberculosis Infection

Distinguished Non-Finalist

Presenter Organization Keck School of Medicine at USC

Presenting Author Dorothy Han

Track Adult

Keywords

peritoneal tuberculosis

extrapulmonary TB

ascites

omental caking

Mycobacterium tuberculosis

infliximab

caseating granulomas

MTB PCR

abdominal pain

RIPE therapy

Extrapulmonary Tuberculosis

Dry Adhesive Tuberculous Peritonitis

Cirrhotic Ascites

RIPE Therapy

Latent Tuberculosis Infection