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Laparoscopic peritoneal biopsy can be crucial for diagnosis of tuberculous peritonitis

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Abstract

A 28-year-old woman was admitted to a nearby hospital because of low-grade fever and lower abdominal pain, where ascites and slightly elevated serum CA125 level were found. Both acid-fast stain (AFS) and polymerase chain reaction (PCR) failed to detect Mycobacterium tuberculosis in her ascitic fluid, sputum, and gastric juice. She was referred to our division under suspicion of tuberculous peritonitis or ovarian carcinoma. Finally, diagnostic laparoscopy was carried out, showing yellowish-white small nodules disseminated on her whole peritoneum with thin fibrous adhesions. Peritoneal biopsy of these nodules showed epithelioid cell granulomas without caseous necrosis. AFS and PCR again failed to show any evidence of Mycobacterium tuberculosis in these biopsied samples. Based on the laparoscopic findings, however, we thought that she suffered from tuberculous peritonitis. Antituberculous therapy was started and she improved soon. Later, Mycobacterium tuberculosis was demonstrated in the 4-week culture of a peritoneal biopsy specimen. We conclude that laparoscopy may be the only way to detect Mycobacterium tuberculosis in tuberculous peritonitis whenever doubtful but no direct evidence is obtained.

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References

  1. Chow KM, Chow CBY, Szeto CC. Indication for peritoneal biopsy in tuberculous peritonitis. Am J Surg. 2003;185:567–73.

    Article  PubMed  Google Scholar 

  2. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis-presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005;22:685–700.

    Article  CAS  PubMed  Google Scholar 

  3. Shakil AO, Korula J, Kanel GC, Murray NG, Reynolds TB. Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease: a case control study. Am J Med. 1996;100:179–85.

    Article  CAS  PubMed  Google Scholar 

  4. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003;163:1009–21.

    Article  PubMed  Google Scholar 

  5. Bouma BJ, Tytgat KMAJ, Schipper HG, Kager PA. Be aware of abdominal tuberculosis. Neth J Med. 1997;51:119–22.

    Article  CAS  PubMed  Google Scholar 

  6. Piura B, Rabinovich A, Leron E, Yanai-Inbar I, Mazor M. Peritoneal tuberculosis mimicking ovarian carcinoma with ascites and elevated serum CA-125: case report and review of literature. Eur J Gynaec Oncol. 2002;23:120–2.

    CAS  Google Scholar 

  7. Wu JF, Li HJ, Lee PI, Ni YH, Yu SC, Chang MH. Tuberculous peritonitis mimicking peritonitis carcinomatosis: a case report. Eur J Pediatr. 2003;162:853–5.

    Article  PubMed  Google Scholar 

  8. Straughn JM, Robertson MW, Partridge EE. A patient presenting with a pelvic mass, elevated CA-125, and fever. Gynecol Oncol. 2000;77:471–2.

    Article  CAS  PubMed  Google Scholar 

  9. Dwivedi M, Misra SP, Misra V, Kumar R. Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Am J Gastroenterol. 1990;85:1123–5.

    CAS  PubMed  Google Scholar 

  10. Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004;120:305–15.

    CAS  PubMed  Google Scholar 

  11. Mazurek GH, Villarino ME. CDC. Guidelines for using the QuantiFERON®-TB test for diagnosing latent Mycobacterium tuberculosis infection. MMWR. 2003;52:15–8.

    PubMed  Google Scholar 

  12. Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection: an interferon-gamma-based assay using new antigens. Am J Respir Crit Care Med. 2004;170:59–64.

    Article  PubMed  Google Scholar 

  13. Bhargava DK, Shriniwas, Chopra P, Nijhawan S, Dasarathy S, Kushwaha AK. Peritoneal tuberculosis: laparoscopic patterns and its diagnostic accuracy. Am J Gastroenterol 1992;87:109–12.

  14. Gulati MS, Sarma D, Paul SB. CT appearances in abdominal tuberculosis. Clin Imaging. 1999;23:51–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We give special thanks to Dr. Iwao Emura and Dr. Hiroyuki Usuda for their contribution to pathological assessments of the case.

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Correspondence to Tomofumi Miura.

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Miura, T., Nakamura, J., Yamada, S. et al. Laparoscopic peritoneal biopsy can be crucial for diagnosis of tuberculous peritonitis. Clin J Gastroenterol 2, 408–411 (2009). https://doi.org/10.1007/s12328-009-0119-3

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  • DOI: https://doi.org/10.1007/s12328-009-0119-3

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