| Peritoneal tuberculosis is an infrequent location of the tubercular infection. It is generally found in patients with underlying immuno-suppression (HIV, diabetes, immunosuppressant drugs, etc).The peritoneal cavity is contaminated via the hematogenous route, the primary focus being a pulmonary infection; or by local extension through other organs, such as the genital organs.
Generally it is associated with ascites produced by the exudation of a fluid rich in protein, originating from the numerous tubercles implanted in the peritoneum.
The most frequent symptoms and signs are ascites (in more than the 90% of cases), fever and abdominal pain.
The diagnosis should always be suspected for any patient with ascites and fever. A diagnostic paracentesis should be performed for biochemical analysis and microbiology of the ascitic fluid. Fluid with lymphocytic predominance and a gradient of albumen serum/ascites <1.1 g/d is highly suggestive. The cultures obtained by guided-biopsy are the most worthwhile (95% of positive diagnosis). Genome amplification of the mycobacteria by PCR is highly sensitive (100%) and specific (97%) and is a very useful technique if available. The determination of ADA with a point of reference between 36 and 40 UI/L is also useful, especially in non-cirrhotic patients.
Several CT slices are shown demonstrating straightening of the intestinal loops caused by rigidity of the mesentery (figure 1), dense ascites clearly outlined by the peritoneal inflammatory reaction (figure 2) and traction of the blood vessels by a loss of elasticity of the mesentery secondary to the fibrotic reaction of the infectious process (figures 3, 4). Nevertheless, all these radiological signs are nonspecific and they do not preclude the tests previously mentioned.
Authors:
Juan Valle Puey
Juan I. Pérez Calvo
Serviço de Medicina Interna
María Asunción Vitoria
Serviço de Microbiologia
Hospital Clínico Universitário “Lozano Blesa”
Translation: Kelly
Watt
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