• Ascites
• Ascitic fluid analysis
• Cirrhosis
• Differential diagnosis

The number of cases of tuberculosis as a complication in people with immunodeficiency, people on immunosuppressive therapy and among the immigrant population is increasing in Germany. However, tuberculous peritonitis rarely occurs without these risks, particularly in Germans. The incidence of tuberculous peritonitis in Germany is very low; tuberculosis of the intestinal tract was found in approximately 0.8 % of tuberculosis cases in 2004. The diagnosis of tuberculous peritonitis is often delayed on account of non-specific clinical symptoms. The absence of specific biological markers, long incubation times for cultures and non-specific radiographic or ultrasonographic signs increase the morbidity associated with this treatable condition.

We report a case of tuberculous peritonitis in a 73-year-old female German patient. Her medical history revealed primary biliary cirrhosis (PBC) since 1992. On admission, she complained of abdominal pain, vomiting, ascites and peripheral edema. The patient has been in a seriously reduced general condition and had fever up to 39.6°C. A few weeks earlier, the patient was in another hospital with the same complaint. Inflammatory parameters were elevated, but the procalcitonin level was normal. Blood culture was always negative, as was the tuberculin test. Ultrasonography of the abdomen showed massive ascites with multiple septa. The patient underwent a computed tomography (CT) scan of the abdomen which showed a thickened intestinal wall in the sigmoid colon and a pronounced enhancement of the peritoneum. Computed tomography scans of the lung showed only slight bilateral pleural effusion. Because of the anaesthetic and bleeding risk due to thrombocytopenia, laparoscopy was not immediately undertaken. The culture from ascites was positive for M.tuberculosis after three weeks.

In primary biliary cirrhosis patients with non-specific clinical symptoms, such as vomiting, abdominal pain, ascites, weight loss, and fever, tuberculous peritonitis must be considered in the initial differential diagnosis, although these symptoms may be attributed to cirrhosis of the liver with spontaneous bacterial peritonitis. Ultrasonographic and CT scab findings are not specific for tuberculous peritonitis, but an awareness of the ultrasonographic features and the features of the CT scan may help in the diagnosis of tuberculous peritonitis and avoid clinical mismanagement.

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Female
• Hospitals, University
• Humans
• Incidence
• Male
• Middle Aged
• Morocco
• Peritonitis, Tuberculous/diagnosis
• Peritonitis, Tuberculous/drug therapy
• Peritonitis, Tuberculous/epidemiology
• Retrospective Studies

• Adult
• Aged
• Biopsy
• CA-125 Antigen/blood
• Diagnosis, Differential
• Female
• Humans
• Middle Aged
• Ovarian Neoplasms/diagnosis
• Ovarian Neoplasms/diagnostic imaging
• Ovarian Neoplasms/pathology
• Ovarian Neoplasms/surgery
• Peritonitis, Tuberculous/diagnosis
• Peritonitis, Tuberculous/diagnostic imaging
• Peritonitis, Tuberculous/pathology
• Peritonitis, Tuberculous/surgery
• Retrospective Studies
• Tomography, X-Ray Computed
• Ultrasonography

• Adenosine Deaminase/analysis
• Antitubercular Agents/therapeutic use
• Biopsy, Needle
• DNA, Viral/analysis
• Humans
• Ileal Neoplasms/complications
• Ileal Neoplasms/diagnosis
• Lymphoma, B-Cell/complications
• Lymphoma, B-Cell/diagnosis
• Male
• Middle Aged
• Mycobacterium tuberculosis/genetics
• Peritonitis, Tuberculous/complications
• Peritonitis, Tuberculous/diagnosis
• Polymerase Chain Reaction
• Tuberculosis, Gastrointestinal/complications
• Tuberculosis, Gastrointestinal/diagnosis

• Adult
• Aged
• Antitubercular Agents/therapeutic use
• Drug Therapy, Combination
• Female
• HIV Seronegativity
• HIV Seropositivity
• Humans
• Male
• Middle Aged
• Mycobacterium tuberculosis/isolation & purification
• Peritonitis, Tuberculous/diagnosis
• Peritonitis, Tuberculous/drug therapy
• Radiography, Thoracic

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.

METHODS: The records of 11 patients (4 males, 7 females, mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.

RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white ‘miliary nodules’ or plaques, enlarged lymph nodes, ascites, ‘violin string’ fibrinous strands, and omental thickening. Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis (M. tuberculosis) in all cases.

CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.

• Abdomen
• Adolescent
• Adult
• Aged
• Ascites/diagnosis
• Ascites/microbiology
• Diagnosis, Differential
• Female
• Humans
• Male
• Middle Aged
• Peritonitis, Tuberculous/diagnosis
• Retrospective Studies
• Tuberculosis, Gastrointestinal/diagnosis
• Tuberculosis, Lymph Node/diagnosis