Tuberculosis peritoneal. Una forma de presentación poco frecuente de una enfermedad emergente en pediatría / Peritoneal tuberculosis. A rare form of presentation of an emerging disease in pediatrics

La tuberculosis constituye un importante problema sanitario, que afecta a un tercio de la población mundial. La localización pulmonar es la más frecuente, y es rara la presentación perito-neal. Las manifestaciones clínicas son inespecíficas, por lo que el diagnóstico requiere de un alto nivel de sospecha.Se comunica el caso de una adolescente de 13 años hospitali-zada por tuberculosis peritoneal. El objetivo es describir una forma poco frecuente de manifestación extrapulmonar de la infección por M. tuberculosis en la edad pediátrica y concien-tizar a la comunidad médica, en el contexto epidemiológico actual, sobre la reemergencia de esta enfermedad y la impor-tancia del diagnóstico y tratamiento oportunos, así como de reforzar las medidas de control y prevención.

Tuberculosis constitutes an important health problem, affect-ing one third of the world's population. The pulmonary lo-calization is the most frequent one, being rare the peritoneal presentation. Clinical manifestations are non-specific so the diagnosis requires a high level of suspicion.The case of a 13-year-old teenager hospitalized for peritoneal tuberculosis is reported. The objective is to describe a rare form of extra-pulmonary manifestation of M. tuberculosis infection in the pediatric age and to sensitize the medical community, in the current epidemiological context, to the reemergence of this disease and the importance of timely diagnosis and treat-ment as well as strengthening control and prevention measures.

Peritonitis tuberculosa en un niño / Pediatric tuberculous peritonitis: case report

Resumen La peritonitis tuberculosa es una entidad infrecuente en la población pediátrica. Es una forma poco común de tuberculosis extrapulmonar y representa un muy bajo porcentaje de todos los casos de tuberculosis. Sus síntomas son inespecíficos, manifestándose usualmente con ascitis, dolor abdominal, fiebre y baja de peso. El retraso en su diagnóstico y tratamiento, dada su forma de presentación, puede incrementar su morbimortalidad. Se comunica el caso de una adolescente de 14 años, previamente sana, quien se presentó con fiebre y ascitis. La laparoscopia demostró múltiples nódulos en la cavidad abdominal compatibles con una tuberculosis peritoneal, la cual fue posteriormente confirmada por cultivo y biología molecular. La paciente completó su tratamiento antituberculoso recuperándose en forma satisfactoria.

Tuberculous peritonitis is an uncommon entity in the infant population. It is an uncommon form of extrapulmonary tuberculosis and represents a very low percentage of all cases of tuberculosis. Its symptoms are nonspecific and usually manifesting with ascites, abdominal pain, fever and low weight. The delay in its diagnosis and treatment, originated by its form of presentation, can cause an increase in its morbidity and mortality. We report the case of a 14-year-old patient without concomitant disease or pulmonary tuberculosis, who presented with ascites and fever. Laparoscopy showed multiple nodules in the abdominal cavity compatible with peritoneal tuberculosis, which was subsequently confirmed by culture and molecular test. The patient completed her antituberculosis treatment recovering satisfactorily.

Tuberculosis extrapulmonar con compromiso peritoneal. Reporte de caso clínico y revisión de literatura / Extrapulmonary tuberculosis with peritoneal compromise. Case clinical report and literature review

Extrapulmonary tuberculosis accounts for a significant proportion of tuberculosis cases worldwide (about 20-25% of the cases). Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Peritoneal tuberculosis is due to the infection of Mycobacterium tuberculosis in the peritoneum. It represents 0.7% of total cases of tuberculosis. This disease can mimic malignancy specially in women, because of its clinical presentation with ascites, weight loss and similar radiological sings. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease. We present the clinical case of a Haitian woman who presented ascites, abdominal pain and weight loss with radiological signs that suggested peritoneal carcinomatosis, in which further studies of ascitic fluid showed elevated adenosindeaminase, a specific and sensitive finding for tuberculosis. (AU)

A Case of Tuberculous Liver Abscess Developed during Chemotherapy for Tuberculous Peritonitis as Paradoxical Response / 대한소화기학회지

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diasnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.

Tuberculosis peritoneal: informe de siete casos / Peritoneal tuberculosis: report of seven cases

Introducción: La tuberculosis peritoneal es una entidad clínica con baja frecuencia de presentación y por mucho tiempo casi olvidada de la práctica clínica. Casos clínicos: Presentación y análisis de siete casos con diagnóstico de tuberculosis peritoneal, tratados en cuatro hospitales de la ciudad de Aguascalientes, en un periodo de cinco años, que presentaron las siguientes características: edad promedio de 47.5 ± 6.5 años; seis de ellos del sexo femenino y uno del masculino. Dos pacientes tenían el antecedente de tuberculosis pulmonar. Los datos clínicos más relevantes fueron dolor abdominal en seis, ascitis en cuatro y dolor abdominal en tres. El tiempo de evolución promedio de los síntomas fue de 5 ± 1.7 meses. Los hallazgos tomográficos identificados fueron tumor ovárico unilateral en cuatro y bilateral en dos, ascitis en cuatro y adenopatía retroperitoneal en uno. A los seis pacientes del sexo femenino se les encontró niveles elevados de CA125, con mediana de 419 U/ml (286 a 512 U/ml). Se sospechó neoplasia maligna en el preoperatorio en todos los casos, por lo que fueron operados en forma electiva. Se realizó laparotomía con biopsia en tres, laparotomía con salpingo-ooforectomía en dos y laparoscopia con biopsia en dos. Se sospechó tuberculosis peritoneal al momento de la cirugía en todos. El promedio de estancia hospitalaria fue de 2 ± 0.5 días. No se presentaron complicaciones ni muertes hospitalarias. Conclusiones: La tuberculosis peritoneal es una enfermedad rara que se presenta cada vez con mayor frecuencia. Debe considerarse el diagnóstico en pacientes jóvenes con tumor anexial, ascitis y elevación de CA125.

BACKGROUND: Peritoneal tuberculosis (TB) is a misdiagnosed clinical entity of low frequency. Due to its rarity, it requires a high index of suspicion in clinical practice. Its incidence has been increasing in recent years. CLINICAL CASES: We present and analyze seven cases of peritoneal TB diagnosed and treated at four hospitals in Aguascalientes, Mexico during a 5-year period. Mean age of the patients was 47.5 +/- 6.5 years. There were six females and one male. Two patients had a history of treated lung TB. The most frequent clinical data were abdominal pain (six patients), ascites (four patients), and abdominal tumor (three patients). Symptom duration prior to surgery was 5.0 +/- 1.7 months. Abdominopelvic CT examinations revealed unilateral ovarian tumor in four patients, bilateral ovarian tumor in two patients, ascites in four patients, and retroperitoneal adenopathy in one patient. All female patients had elevated serum CA-125 levels with a median of 419 U/ml (range: 286-512 U/ml). All patients had a preoperative diagnosis of malignant tumor. All surgical procedures were elective and consisted of laparotomy with biopsy in three patients, laparotomy with salpingo-oophorectomy in two patients, and laparoscopy with biopsy in two patients. Diagnosis of TB was suspected in all cases during surgery. Mean hospital stay was 2 +/- 0.5 days. There was no postoperative morbidity or mortality. CONCLUSIONS: Peritoneal TB is uncommon. Diagnoses should be considered in all patients with ascites, adnexal tumors and elevated serum CA-125 levels.

[Peritoneal tuberculosis - report of 43 cases]

Peritoneal tuberculosis represents 0, 1 to 4% of all forms of tuberculosis. The aim of our study is to describe clinical, therapeutic characteristics and the outcome of peritoneal tuberculosis. Retrospective study of all cases of peritoneal tuberculosis diagnosed in gastroenterology B department - Rabta Hospital during a 12 years period [1996 to 2007]. Forty three cases of peritoneal tuberculosis were included: 15 male and 28 female with mean age of 38years [extremes: 16 to 85years]. Five patients were cirrhotic. Clinical manifestations were dominated by ascitis [83%]. Ascitic fluid were exsudative in 97% of cases and lymphocytic in all cases. The diagnostic was based on coelioscopy with peritoneal biopsy in 26cases demonstrating caseating granulomatous lesions in 64% of cases. Extra peritoneal tuberculosis was noted in 60, 4% dominated by pleuro-pulmonary localisations. Patients were given antituberculous therapy for a mean duration of 9, 8 months and the outcome was favourable in 93%. Peritoneal tuberculosis is still a medical problem in Tunisia. It is more common in young female. Diagnosis is based on the results of peritoneal biopsies during coelioscopy. The outcome is good in most cases after antituberculous treatment

Multifocal idiopathic fibrosclerosis mimicking tuberculosis of the abdomen.

We present a 13 year old girl from Assam who had been treated as abdominal tuberculosis for 2 years due to the presence of refractory lymphocyte-predominant ascites and multiple small bowel strictures associated with significant anorexia and weight loss. On evaluation she was found to have retroperitoneal fibrosis with hydroureteronephrosis, mediastinal fibrosis and a retro-orbital pseudotumour. Based on these findings the diagnosis of Multifocal Idiopathic Fibrosclerosis (MIFS) was made. Ascites and multiple bowel strictures have been only rarely been described in association with MIFS. The other unique features in this patient were the early age of presentation, the presence of mediastinal fibrosis in association with retroperitoneal fibrosis, extensive soft tissue fibrosis of the neck, axillae and the presence of trismus. In a country like ours where Tuberculosis is commonplace, one would not think twice about treating such a case with antituberculous therapy. However, with a constellation of findings suggestive of a diffuse fibrotic process, MIFS should be an important consideration.©

Peritoneal tuberculosis with gastric cancer: a case report / Tuberculosis peritoneal con cáncer gástrico: reporte de caso

This is a report of a case with both peritoneal tuberculosis and gastric cancer. Physicians should have a high index of suspicion of peritoneal tuberculosis if the patient is febrile with a past history of tuberculosis.

Este es el reporte de un caso con tuberculosis peritoneal y cáncer gástrico a la vez. Los médicos debáan tener un alto índice de sospecha de tuberculosis peritoneal si se trata de un paciente febril con antecedentes de tuberculosis.

Tuberculose peritoneal: relato de caso / Peritoneal tuberculosis: case report

A tuberculose peritoneal consiste num processo inflamatório crônico causado pelo Mycobacterium tuberculosis. Sua sintomatologia é inespecífica, com comprometimento sistêmico. É aqui descrito o caso de um paciente de 35 anos de idade, alcoólatra, portador de cirrose hepática. Seu diagnóstico foi definido após realização de biópsia peritoneal feita durante a laparotomia exploradora. Iniciou-se o tratamento preconizado e o paciente recebeu alta em boas condições clínicas.

Tuberculosis genital y CA-125 elevado / Genital tuberculosis and high CA-125 titles

Se presenta caso de tuberculosis genital en mujer joven con títulos altos de CA-125 y diagnóstico inicial de carcinomatosis peritoneal de probable origen ovárico. Se compara hallazgos con lo reportado en la literatura a tráves de los 20 años en Medline y se discute su tratamiento

Aspectos do diagnóstico por imagem da tuberculose peritoneal / Aspects of diagnosis imaging of peritoneal tuberculosis. Review articles and case report

Os autores apresentam o caso de paciente etilista crônico com tumor abdominal e ascite. Este estudo mostra as dificuldades diagnósticas na primeira fase da investigaçäo. A avaliaçäo ultra-sonográfica, associada à tomografia computadorizada do abdome, mostrou espessamento peritoneal difuso. Este achado foi de fundamental importância para o diagnóstico clínico e etiológico da tuberculose peritoneal. Além da apresentaçäo do caso, os autores revisam a literatura sobre o assunto.

Tuberculose peritoneal: Relato de um caso / Peritoneal tuberculosis: A case report

Os autores descrevem um caso de tuberculose peritoneal solucionado através de prova terapêutica. Tratava-se de menina de nove anos com ascite cuja punçäo mostrou líquido amarelo com elevaçäo de proteínas e predomínio de linfócitos. A evoluçäo foi favorável

Tuberculose peritoneal: relato de um caso e revisäo de literatura / Peritoneal tuberculosis: a case report and literature review

Os autores relatam um caso de tuberculose peritoneal em paciente do sexo masculino, de 65 anos de idade, que apresentava quadro de ascite, dor abdominal e emagrecimento progressivo há aproximadamente 4 meses. Foi tratado com esquema tríplice (rifampicina, isoniazida e pirazinamida), obtendo-se excelente resultado. Apresentam ainda, uma revisäo literária do assunto, enfatizando a importância do diagnóstico e tratamento precoce no prognóstico da doença e na sobrevida dos pacientes.

Tuberculosis abdominal / Abdominal tuberculosis

Se evaluaron 20 casos de tuberculosis (TBC) abdominal; de los cuales 10

Peritonitis nodular fibrocalcificada idiopática: descripción de un caso clínico / Fibrocalcificated nodular idiopathic peritonitis: description of a case

Presentamos el caso de una paciente de 51 años de edad, previamente sana, que debuta con una obstrucción intestinal, cuya causa está en una forma de peritonitis localizada, con formación de nódulos de antigua data, en los cuales es imposible, a través de diversos métodos, determinar su etiología. La revisión del caso nos ha llevado a un análisis de la bibliografía sobre este tema, concluyendo que no existen referencias similares

Tuberculous peritonitis the value of laparoscopy in diagnosis

Of 93 patients with a provisional and laparoscopic diagnosis of tuberculous peritonitis, 91 [97.8%] patients had tuberculous peritonitis while 2 [2.2%] had peritonitis carcinomatosa. Out of the 91 tuberculous patients, 39 [42.9%] had a highly suggestive clinical picture of tuberculous peritonitis in the form of subacute onset of abdominal swelling and ascites, in addition to fever, abdominal pain, abdominal tenderness and a tense slightly expanded abdomen; 97% of the patients had elevated E.S.R. Associated pleural effusion was present in 15.4% and pulmonary tuberculosis, in 2.2% of the patients. Thirty three [54%] had noncaseous tuberculous granuloma while 20 [32.0%] had caseous ones. Bacteriological studies for Mycobacterium tuberculosis, were positive in 76.6% of the patients and guinea pig inoculation was the most sensitive method for detection of Mycobacterium tuberculosis followed by culture and lastly by smear. Laparoscopy suggested the diagnosis in 96.7% of patients with final diagnosis of tuberculous ascites. Laparoscopy can be considered the technique of choice for diagnosis of tuberculous peritonitis. Visual diagnosis though highly informative, does not preclude sampling for bacteriologic and histopathologic confirmation. A significant and progressive improvement was reported in patients attending the follow-up after antituberculous therapy

Tuberculosis peritoneal / Peritoneal tuberculosis

Se efectúan algunas consideraciones generales sobre la infección tuberculosa, enfatizándose las características de la localización peritoneal de la enfermedad. Se menciona su presentación como forma siempre secundaria a otro foco tuberculoso pulmonar o de otro órgano vecino abdominopelviano, como intestino o genitales interno. Se relata la historia de un escolar de 9 años con ascitis en que se establece el diagnóstico de tuberculosis peritoneal. Se presentan los casos de tuberculosis peritoneal en los últimos 10 años en nuestra institución