SHM Converge Scientific Abstract ePoster Gallery-When Omental Thickening Lies: The Case of Hidden Tuberculosis

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This case describes a 32-year-old Hispanic man who presented with 5 days of progressive abdominal pain, distention, fullness, fever, chills, and one episode of vomiting. CT imaging showed moderate ascites, diffuse peritoneal enhancement, omental thickening, and mildly enlarged lymph nodes, raising concern for peritoneal carcinomatosis versus infection. Initial labs showed mild transaminitis and hypoalbuminemia. Paracentesis revealed lymphocyte-predominant ascites with a low SAAG, making portal hypertension less likely.<br /><br />Because the imaging strongly suggested malignancy, the patient underwent multidisciplinary evaluation by Oncology, Gastroenterology, and Infectious Disease. Key historical details increased suspicion for tuberculosis: prior construction work in Guatemala and current occupational exposure to coworkers traveling from Latin America. Further workup showed a positive QuantiFERON-TB Gold test. Lymph node biopsy demonstrated non-caseating granulomas, and peritoneal fluid culture later grew Mycobacterium tuberculosis after 29 days. The patient was started on RIPE therapy and improved markedly.<br /><br />The report emphasizes that tuberculous peritonitis is a rare but important extrapulmonary form of tuberculosis that often mimics cancer, especially peritoneal carcinomatosis. Imaging findings such as omental thickening and peritoneal enhancement are not specific and can mislead clinicians. Histology showing non-caseating granulomas does not exclude TB, so diagnosis must integrate epidemiologic risk, clinical presentation, pathology, and microbiology.<br /><br />The main lesson is to keep extrapulmonary TB on the differential for lymphocytic, low-SAAG ascites even without pulmonary symptoms. Early recognition can prevent unnecessary invasive oncologic workups and allow timely, potentially life-saving treatment.

Asset Subtitle

Monica Correa-Alfonzo

Meta Tag

Author List Ardit Feinaj, Christiane Martell, Daniela Carralero-Somoza, Joffre Rivera, Monica Correa-Alfonzo, Vivan Loveday-Laghi, Zoya Khan

Category Clinical Vignettes

Concept Dry Adhesive Tuberculous Peritonitis

Concept Lymphocyte-Predominant Ascites

Concept Serum-Ascites Albumin Gradient

Concept RIPE Therapy

Concept Peritoneal Carcinomatosis

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Monica Correa-Alfonzo

Track Adult

Keywords

tuberculous peritonitis

peritoneal carcinomatosis

ascites

Mycobacterium tuberculosis

RIPE therapy

low SAAG

lymphocytic ascites

omental thickening

peritoneal enhancement

extrapulmonary tuberculosis

Dry Adhesive Tuberculous Peritonitis

Lymphocyte-Predominant Ascites

Serum-Ascites Albumin Gradient

RIPE Therapy

Peritoneal Carcinomatosis