Non-Hodgkin lymphoma with high adenosine deaminase levels mimicking peritoneal tuberculosis: An unusual presentation

Abstract

Abdominal tuberculosis is still a medical problem in developing countries. The clinical presentation of tuberculous (TB) peritonitis may be similar to that of peritoneal carcinomatosis. Therefore, its diagnosis is rather difficult only with laboratory investigations. Ascitic fluid adenosine deaminase (ADA) activity has been proposed as a useful diagnostic test in tuberculous peritonitis, as many studies reported high ADA levels in TB peritonitis. On the other hand, ADA activity is usually lower in peritoneal carcinomatosis and malignant ascites. This study described a patient with non-Hodgkin lymphoma with elevated (67 U L(-1)) ADA levels and clinical signs mimicking peritoneal tuberculosis. On admission, this study focused on the high value of ADA in ascites and strongly suspected TP. Although anti-tuberculous agents were initiated, his general condition did not improve. Finally, laparoscopic peritoneal biopsy was performed and non-Hodgkin lymphoma diagnosed. In the light of these findings, ADA level may not reflect TB peritonitis in the absence of histopathological examination. Therefore, non-Hodgkin lymphoma should be kept in mind in the differential diagnosis in patients with high ascitic fluid ADA levels and in non-responders to anti-tuberculosis treatment.

Adenosine deaminase activity in patients with ovarian neoplasms

“…In clinical practice, it is frequently considered as a noninvasive diagnostic test for tuberculosis with 90-100% sensitivity and 89-100% specificity [3]. Additionally, it has been shown in several studies that ADA activities may be useful both in diagnosis and monitoring of some malignancies [4][5][6]. Most of these studies are based on purine enzymatic differences between benign and cancer tissues.…”

Leptin levels in the differential diagnosis between benign and malignant ascites

“…Especially diagnosis of exudative ascites (including lymphoma, various for ms of peritonitis, peritoneal carcinomatosis, and peritoneal tuberculosis) is a dilemma. Non-invasive tests such as laboratory tests, acid-fast stain and culture of the ascitic fluid, ADA levels are usually insufficient for the differential diagnosis of ascites [19,20] . Therefore laparoscopy with directed biopsy is necessary for the diagnosis of ascites.…”

A case of bilateral pleural effusion as the first sign of multiple myeloma

“…The increased ADA was commonly found in the tuberculous pleural fluid. Nevertheless, an elevated ADA activity in pleural fluid has also been reported in some cases of benign or malignant diseases, such non-Hodgkin’s lymphoma, breast cancer [7,8]. Yokoyama et al also reported a myelomatous pleural effusion case with high ADA activity in pleural effusion [9], but the ADA activity in our patient was much higher.…”