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Tuberculous peritonitis in a German patient with primary biliary cirrhosis: a case report.

Vogel Y, Bous JC, Winnekendonk G, Henning BF - J Med Case Rep (2008)

Bottom Line: 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.The patient has been in a seriously reduced general condition and had fever up to 39.6 degrees C.The culture from ascites was positive for M.tuberculosis after three weeks.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Gastroenterology Unit, Marienhospital, Ruhr University, Herne, Germany. yilin.vogel@marienhospital-herne.de

ABSTRACT

Background: 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.

Case presentation: 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 degrees 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

CT pelvis pronounced contrast enhancement of the peritoneum (); thickened wall of the sigmoid colon ().
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Figure 1: CT pelvis pronounced contrast enhancement of the peritoneum (); thickened wall of the sigmoid colon ().

Mentions: CT scan of the chest showed bilateral pleural effusions without lymph node swellings. Abdominal ultrasonography revealed massive ascites with multiple septa. A CT scan of the abdomen showed a thickened intestinal wall located in the sigmoid colon (Fig. 1) and pronounced enhancement of the peritoneum. There were no masses or lymph node swellings in the abdominal cavity. Esophagogastroscopy and ileocoloscopy revealed no ulcer or stenosis in the colon or ileum.


Tuberculous peritonitis in a German patient with primary biliary cirrhosis: a case report.

Vogel Y, Bous JC, Winnekendonk G, Henning BF - J Med Case Rep (2008)

CT pelvis pronounced contrast enhancement of the peritoneum (); thickened wall of the sigmoid colon ().
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2267201&req=5

Figure 1: CT pelvis pronounced contrast enhancement of the peritoneum (); thickened wall of the sigmoid colon ().
Mentions: CT scan of the chest showed bilateral pleural effusions without lymph node swellings. Abdominal ultrasonography revealed massive ascites with multiple septa. A CT scan of the abdomen showed a thickened intestinal wall located in the sigmoid colon (Fig. 1) and pronounced enhancement of the peritoneum. There were no masses or lymph node swellings in the abdominal cavity. Esophagogastroscopy and ileocoloscopy revealed no ulcer or stenosis in the colon or ileum.

Bottom Line: 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.The patient has been in a seriously reduced general condition and had fever up to 39.6 degrees C.The culture from ascites was positive for M.tuberculosis after three weeks.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Gastroenterology Unit, Marienhospital, Ruhr University, Herne, Germany. yilin.vogel@marienhospital-herne.de

ABSTRACT

Background: 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.

Case presentation: 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 degrees 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus