Tuberculous Peritonitis: An Unusual Diagnosis For Vague Abdominal Pain

Mycobacterium Tuberculosis (MTB) continues to affect millions of people worldwide and remains a significant cause of mortality in those who contract the disease and do not receive proper treatment. This phenomena also explains why this disease continues to be transmitted when they are not properly isolated. Predominantly the focus is on pulmonary TB but that is only one of many complications of the disease. Miliary TB occurs when the infection hematogenously disseminates throughout the body and causes further complications. When the infection seeds other organ sites it causes unique complications and one of the more worrisome is peritonitis. We report a case of disseminated mycobacterium tuberculosis infection causing peritonitis in a patient presenting with vague complaints of cough, abdominal pain, and weight loss. Patients initial radiologic studies revealed a cavitary lesion in the lung, significant mediastinal, abdominal, and pelvic lymphadenopathy with omental thickening. It was initially thought the patient had a hematologic or gastrointestinal malignancy with diffuse metastases but after bronchoscopy, omental, and lymph node biopsies and cultures were performed it revealed acid-fast bacilli and mycobacterium tuberculosis culture positive infection. Patient was immediately placed in isolation, the health department was contacted, and he was started on directly observed treatment (DOT) with isoniazid, rifampin, ethambutol, and pyrzinamide after results showed his TB infection was susceptible to this regimen. We concluded that patients with significant lymphadenopathy should not be assumed to have malignancy and those with pertinent risk factors should always we screened for TB and have it ruled out as to prevent disseminated infection as this has significant mortality if not treated in a timely fashion.https://scholarlycommons.henryford.com/merf2019caserpt/1101/thumbnail.jp