Peritoneal tuberculosis: the great mimicker

Abstract

Case Presentation An 84-year-old woman presented to an outside institution with a 1-month history of generalized malaise, anorexia, abdominal distension, shortness of breath, and unintentional 20-pound weight loss. She had a past medical history of JAK2-positive polycythemia rubra vera, stage 4 chronic kidney disease, type 2 diabetes mellitus, and hypothyroidism. Her surgical history included a total vaginal hysterectomy and bilateral salpingo-oophorectomy in 1984. Since moving to the United States in 1972, she undertook routine visits to her native country, India. The patient's diabetes was managed with metformin/glipizide and her primary care provider had changed this regimen to sitagliptin 2 weeks prior due to worsening chronic kidney disease. On presentation, vital signs were within normal range aside from mild tachycardia. Her exam was notable for atrophy of the extremities and a protuberant abdomen with a positive fluid wave and shifting dullness. On pelvic examination, the uterus was surgically absent and there was no cul-de-sac nodularity on bimanual or rectovaginal exam. Relevant laboratory values included: hemoglobin 11.7 g/dL, white blood cell count 9850/mm 3 , platelet count 468 000 mm 3 , blood urea nitrogen 46 mg/dL, creatinine 2.5 mg/dL, albumin 2.4 g/dL, albumin-corrected calcium 12.

Asymptomatic peritoneal tuberculosis in a patient with a non-remitting fever and isolated pulmonary symptoms: a case report and literature review

“…CA-125 is a non-specific marker of peritoneal inflammation [5] and can be elevated to a similar degree in both peritoneal TB and metastatic ovarian cancer. The tumour marker has even been proposed as a potential parameter to evaluate treatment success for TB peritonitis [16] .…”

“…This is due to the non-specific and insidious presentation of peritoneal TB [4] . Furthermore, tumour markers such as cancer antigen (CA)-125 can be elevated due to peritoneal involvement, complicating matters further [5] . Peritoneal TB has been associated with a mortality rate of up to 60% when undiagnosed however, prompt diagnosis and commencement of therapy can help successfully cure the condition [4] .…”

Peritoneal thickening: It's not always carcinomatosis

“…Abdominal tuberculosis occurs in 11%-12% of the patients with extra pulmonary disease [2] , and may involve the hepatobiliary system, pancreas, gastrointestinal tract, genitourinary tract, and lymph nodes. In that matter peritoneal tuberculosis accounts for 1% to 3% of the cases [1] and imaging features are frequently overlapping with other conditions, making for frequent misdiagnosis and delays in treatment [3] .…”

Diagnosis challenges of a patient with peritoneal tuberculosis masquerading as ovarian malignancy: a case report

“…29 In patients with peritonitis, abnormal chest radiographs can be found in 21-83% of cases, with active pulmonary TB found in about 14% of cases. 30 However, neither of these findings is diagnostic for PTB and is only suggestive of a possible etiology. 25,30 Radiologically, if the ovaries are significantly enlarged in the definitive tumor, significant peritoneal infiltration indicates peritoneal metastasis.…”