Peritoneal tuberculosis in a woman with ascites and elevated CA 125 who has drug induced liver injury

Abstract

A 30-year-old woman presented with abdominal pain and ascites. She also complained of reduced appetite and weight loss. She was a nurse who managed patients with tuberculosis (TB) in her entire daily duties. Physical examination revealed significant ascites, no lymphadenopathy or hepatosplenomegaly. Respiratory system examination was normal. Laboratory results showed plasma Ca-125 of 345.87 µ/mL and adenosine deaminase (ADA) of 96 U/L on ascitic fluid. Chest X-ray showed hilar lymphadenopathy. The patient was subjected to antituberculosis treatment, but then suffered from drug induced-liver injury. After modification of TB drug regimens, she subsequently improved. Although the acid-fast smear is the golden standard for the diagnosis of peritoneal TB, history of contact and ADA test should be kept in mind when clinical pictures are non-specific, and bacteria culture was negative. The therapeutic effect of TB treatment was assessed clinically, allowing to identify drug effectiveness and earlier diagnosis of DILI.