Peritoneal Tuberculosis Can Present as Cirrhosis with Recurrent Ascites

Abstract

Objectives: Peritoneal tuberculosis is an uncommon site of extrapulmonary infection caused by Mycobacterium tuberculosis. Patients' present like cirrhosis and can be seen in patients with HIV infection, diabetes mellitus, underlying malignancy, immunosuppression and on dialysis. Infection occurs most commonly following reactivation of latent tuberculous foci in the peritoneum that were established from hematogenous spread from a primary lung focus. Methods: Our patient is a 61YO female with PMHx H/O ESRD, Afib, HTN, dilated CMP, and cirrhosis(unknown cause) presented with recurrent ascites. She had multiple hospitalization and paracentesis. Everytime SAAG was < 1.1, fluid was negative for any malignant cells. We explored causes of ascitic with SAAG < 1.1, Abdominal TB(rare cause but still possibility) was added into differential. Pt hx was re-explored, she had exposure to TB patient as a child, and PPD positive though she never had night sweats or low grade fever and was never treated for latent TB. On further workup, CT chest was positive for healed granulomatous nodes. Her ascites subsided within 6 weeks of start of anti-TB rx. Results: Tuberculous peritonitis should be considered in all patients p/w unexplained lymphocytic ascites with a SAAG of < 1.1 g/dL. The diagnosis can be difficult since the onset is insidious, it can have a variable presentation, and it is frequently seen in patients with underlying liver or renal disease. Special attention should be given to TB exposure, PPD testing and any old hilar lymphadenopathy. It should be treated with 9 to 12 months as standard anti-TB treatment protocol. Conclusions: Peritoneal TB should be considered in all patients' p/w unexplained ascites, and should be an important differential in patients with HIV, DM, maliganacy, Hemodialysis and immunosuppression. Once diagnosed, ascites 2/2 TB responds very well to treatment in few weeks and if it isn't recognized, pt keep getting recurrent hospitalizations and paracentesis.