Tuberculous peritonitis in no risk patients: diagnostic approach.
ABSTRACT Incidence of tubercoulosis is increasing in Western countries particularly in immigrants from endemic areas and in patients with HIV or immunocompromised. The disease is unusual in patients without risk factors. In these conditions the diagnosis of tuberculous peritonitis is often delayed, resulting in high morbidity and mortality.
We describe a case of tuberculous peritonitis in a man suffering from ascites referred for presumed peritoneal carcinosis. The finding of no malignancies in the peritoneal fluid must rise the suspect of tuberculosis that, if misdiagnosed, is fatal. The patient was submitted to diagnostic videolaparoscopy and multiple biopsies were done. The definitive histological diagnosis was chronic granulomatous flogosis with giant cells, focally necrotizing, caused by peritoneal tubercolosis.
The patient was submitted to chemotherapy with isoniazide, rifampicine, piazafoline, ethambutol and streptomycine which determined the resolution of the clinical picture.
We believe the diagnostic procedure of choice is videolaparoscopy when tubercolous peritonitis is suspected. This technique allows to obtain selective biopsies of peritoneal nodules and to collect samples for specific cultural and cytohistological exams. The operation is safe, reliable with few complications and permits a prompt diagnosis necessary to cure the patient.
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ABSTRACT: To determine diagnostic features of tuberculous peritonitis (TBP) in the absence and presence of chronic liver disease. Thirty-four patients with TBP (13 without [Group I] and 21 with chronic liver disease [Group II] and 26 controls with cirrhosis and uninfected ascites (Group III) were studied. The clinical features in Groups I and II were similar and all patients had elevated ascitic fluid total mononuclear cell count. In Groups I, II, and III, respectively, ascitic fluid protein was > 25 g/L in 100% (13/13), 70% (14/20), and 0% (0/26); serum-ascites albumin gradient (SAAG) was > 11 g/L in 0% (0/13), 52% (11/21), and 96% (25/26), (0% [0/13], 71% [15/21], and 96% [25/26] after correction for serum globulin); and ascitic fluid lactate dehydrogenase (LDH) level was > 90 U/L in 100% (12/12), 84% (16/19), and 0% (0/20), respectively. In Groups I and II combined, ascitic fluid acid-fast stain was negative in all but Mycobacterium tuberculosis culture was positive in 45% (10/22); peritoneal nodules occurred in 94% (31/33), granulomas in 93% (28/30), and positive peritoneal M tuberculosis culture in 63% (10/16). In patients with suspected TBP, ascitic fluid protein of > 25 g/L, SAAG of < 11 g/L and LDH of > 90 U/L have high sensitivity for the disease. With coexistent chronic liver disease, a lower protein level and higher SAAG are usually not helpful but LDH > 90 U/L is a useful parameter for screening. Diagnosis is best confirmed by laparoscopy with peritoneal biopsy and M tuberculosis culture.The American Journal of Medicine 02/1996; 100(2):179-85. · 4.77 Impact Factor
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ABSTRACT: This article has no abstract. To view the article, select the "View Print Version (PDF)" link above.Gastroenterology 09/1997; 113(2):687-9. · 12.82 Impact Factor
Article: [Peritoneal tuberculosis].[show abstract] [hide abstract]
ABSTRACT: Peritoneal tuberculosis remains a common problem in impoverished areas of the world. Immigrants and AIDS patients are two population groups at particular risk for abdominal tuberculosis in our country. The most common presenting symptoms of tuberculous peritonitis are abdominal pain, ascites and weight loss in more than 80% of cases. Results of sonographics studies are non specific and high serum CA 125 levels can be found. Pulmonary tuberculosis is concomitantly discovered in 50% of cases. Tuberculous peritonitis is of the exsudative type in 95% of cases and requires multiple studies of peritoneal fluid. Tuberculous peritonitis is suspected when exsudate and lymphocytes are present with no malignant cells, and high interferon gamma and adenosine desaminase activity. AFB is detected in the peritoneal fluid cultured conventionally in 80% of cases. Laparoscopy combined with peritoneal biopsy is effective for the diagnosis of tuberculous peritonitis in 75 to 85% of cases. Peritoneal tuberculosis is treated with antituberculous drugs for a period of nine months.Annales de Chirurgie 02/1997; 51(4):375-8. · 0.35 Impact Factor