Peritoneal tuberculosis with negative polymerase chain reaction results: Report of two cases

Peritoneal tuberculosis is rarely observed in European countries. We report on peritoneal tuberculosis in two female immigrants from Somalia and Columbia who presented with diffuse abdominal pain, fever, weight loss and exudative, lymphocytic ascites. Laboratory investigations showed an increase in...

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Bibliographic Details
Published in:Scandinavian journal of gastroenterology 2003-02, Vol.38 (2), p.221-224
Main Authors: SCHWAKE, L, VON HERBAY, A, JUNGHANSS, T, STREMMEL, W, MUELLER, M
Format: Article
Language:English
Subjects:
Adult
Ascites - microbiology
Bacterial diseases
Biological and medical sciences
DNA, Bacterial - analysis
False Negative Reactions
Female
Human bacterial diseases
Humans
Infectious diseases
Medical sciences
Mycobacterium tuberculosis - isolation & purification
Peritoneum - pathology
Peritonitis, Tuberculous - diagnosis
Peritonitis, Tuberculous - pathology
Polymerase Chain Reaction
Tuberculosis and atypical mycobacterial infections
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Summary:Peritoneal tuberculosis is rarely observed in European countries. We report on peritoneal tuberculosis in two female immigrants from Somalia and Columbia who presented with diffuse abdominal pain, fever, weight loss and exudative, lymphocytic ascites. Laboratory investigations showed an increase in C-reactive protein and carcinoma antigen 125 serum levels. Nodular peritoneal lesions and adhesions were detected by ultrasound and computed tomography. In both patients, peritoneal biopsy from laparoscopy revealed epitheloid granulomas with central necrosis and multinucleate giant cells. Microscopy and PCR analysis were, however, negative for Mycobacterium tuberculosis in both patients. Despite repeated testing, ascites culture became positive for M. tuberculosis in only one patient. Shortly after starting antituberculous drug treatment, both patients improved, ascitic fluid disappeared and C-reactive protein and carcinoma antigen 125 serum levels returned to normal. Even in Western countries, peritoneal tuberculosis should be considered in any febrile patient with abdominal signs and symptoms, particularly if ascites is present. Empirical antituberculous treatment is justified in patients with clinical and histological features highly suggestive of peritoneal tuberculosis, even in cases with negative results from microscopy, culture and PCR analysis.
ISSN:0036-5521
1502-7708