SHM Converge Scientific Abstract ePoster Gallery-Under the Radar: A Surprising Twist in a Case of Hepatic Decompensation

Pdf Summary

A 44-year-old chronically alcoholic man from Puducherry presented with abdominal distension, pedal edema, abdominal discomfort, weight loss, and poor appetite. He was initially suspected to have decompensated chronic liver disease, but his liver enzymes, coagulation profile, CBC, and other routine tests were normal. Examination showed ascites and bilateral leg edema without obvious signs of liver failure.<br /><br />Ascitic fluid analysis revealed a low SAAG, marked lymphocytosis, and elevated ADA, suggesting tuberculosis or malignancy. However, CBNAAT and staining for Mycobacterium tuberculosis were negative in both ascitic and pleural fluid, and blood cultures were sterile. Imaging showed gross ascites, omental stranding/haziness, and a moderate left pleural effusion, raising suspicion for peritoneal tuberculosis.<br /><br />Because of the atypical presentation and inconclusive microbiology, an invasive diagnostic approach was pursued. Peritoneal and omental biopsy confirmed the diagnosis of tuberculosis by histopathology and CBNAAT, showing caseating granulomas. The patient was started on anti-tubercular therapy (RIPE) and discharged on day 25.<br /><br />The case highlights that peritoneal tuberculosis can mimic liver decompensation, especially in patients with parenchymal liver disease or alcoholism. It emphasizes the importance of maintaining a high index of suspicion and using biopsy and imaging when routine tests and fluid studies are non-diagnostic, particularly in resource-limited settings.

Asset Subtitle

Adithya Chandran

Meta Tag

Author List Adithya Chandran, Dhiraj Jain, Seetharaman Senthil, Sobhhana Saravanan

Category Clinical Vignettes

Concept Refractory Ascites

Concept Dry Adhesive Tuberculous Peritonitis

Concept Serum-Ascites Albumin Gradient

Concept Extrapulmonary Tuberculosis

Concept Peritoneal Biopsy

Distinguished Non-Finalist

Presenter Organization Indira Gandhi Medical College and Research Institute

Presenting Author Adithya Chandran

Track Adult

Keywords

peritoneal tuberculosis

ascites

omental stranding

low SAAG

lymphocytosis

elevated ADA

caseating granulomas

CBNAAT

anti-tubercular therapy

alcoholic liver disease

Refractory Ascites

Dry Adhesive Tuberculous Peritonitis

Serum-Ascites Albumin Gradient

Extrapulmonary Tuberculosis

Peritoneal Biopsy