SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Mycobacterial Peritonitis?

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A 38-year-old man with heavy alcohol use and prior immigration from Mexico presented with 12 days of jaundice and 3 days of abdominal pain, bloating, and subjective fevers. Exam and labs suggested liver disease with ascites and fibrosis. Initial paracentesis showed a high white blood cell count with marked lymphocyte predominance and a high SAAG, raising concern for infection. CT imaging demonstrated omental caking, and subsequent testing showed a positive QuantiFERON Gold and elevated ascitic adenosine deaminase, both supportive of tuberculosis peritonitis.<br /><br />Although ascitic TB PCR was negative and chest CT showed no pulmonary TB, omental biopsy revealed necrotizing and non-necrotizing granulomatous inflammation without malignancy or organisms. Based on the overall clinical picture, the patient was started on empiric four-drug anti-tuberculosis therapy. Twelve days later, ascitic fluid culture grew Mycobacterium tuberculosis, confirming the diagnosis.<br /><br />The case highlights that tuberculosis peritonitis can present with nonspecific abdominal symptoms and may mimic spontaneous bacterial peritonitis or malignancy. Diagnostic paracentesis is the key initial test, and lymphocytic ascites should prompt suspicion for TB, especially in patients with risk factors such as cirrhosis or alcohol-related liver disease. Imaging and tissue pathology can provide important clues when direct microbiologic tests are negative. Because microscopy and PCR are often falsely negative and cultures may take time to become positive, empiric treatment may be necessary when clinical suspicion is high.

Asset Subtitle

Taylor Robinson

Meta Tag

Author List Paul W. Helgerson, Taylor Robinson

Category Clinical Vignettes

Concept Dry Adhesive Tuberculous Peritonitis

Concept Cirrhotic Ascites

Concept Lymphocytic Ascites

Concept Abdominal Pain

Concept Paracentesis

Distinguished Non-Finalist

Presenter Organization University of Virginia

Presenting Author Taylor Robinson

Track Adult

Keywords

tuberculosis peritonitis

lymphocytic ascites

cirrhosis

omental caking

QuantiFERON Gold

adenosine deaminase

Mycobacterium tuberculosis

granulomatous inflammation

paracentesis

empiric anti-tuberculosis therapy

Dry Adhesive Tuberculous Peritonitis

Cirrhotic Ascites

Lymphocytic Ascites

Abdominal Pain

Paracentesis