1/104. Tuberculous peritonitis: fatality associated with delayed diagnosis.We describe a fatal case of tuberculous peritonitis and review the literature on the diagnostic modalities available to diagnose this entity. We suspect a delayed diagnosis resulted in the death of our patient. Today, the prompt diagnosis of an unknown ascitic process involves laparoscopy. A patient with unknown large volume ascites is the easiest and safest to laparoscope. Using a mini laparoscope, a bedside procedure with instantaneous return can be done. The newer noninvasive tests like determination of ascites fluid adenosine deaminase activity and polymerase chain reaction may be helpful in the prompt diagnosis of peritoneal tuberculosis. We recommend that patients with clinical presentation suggestive of peritoneal tuberculosis have either an aggressive diagnostic workup using high-yield tests or a trial of antituberculous therapy.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
2/104. Disseminated tuberculosis: still a diagnostic challenge.Disseminated tuberculosis is notoriously difficult to diagnose and, with the decrease in tuberculosis incidence in australia, familiarity with its manifestations has dwindled. We describe four bacteriologically proven cases which illustrate the range of presentations and diagnostic difficulties. Surprisingly, immunosuppressive therapy need not cause rapid deterioration. Disseminated tuberculosis should be considered in any patient with multisystem illness who is at risk of tuberculosis, particularly if born overseas. In the absence of confirmatory results, a prompt therapeutic trial may be life-saving.- - - - - - - - - - ranking = 4keywords = tuberculosis (Clic here for more details about this article) |
3/104. tuberculosis peritonitis: gallium-67 scintigraphic appearance.tuberculosis peritonitis is a rare manifestation of extrapulmonary tuberculosis. The results of gallium-67 scintigraphy of three patients with tuberculosis peritonitis were reviewed to assess its usefulness in the diagnosis of this condition. tuberculosis peritonitis was associated with diffuse or focal abdominal localization and decreased hepatic accumulation of gallium-67. These gallium-67 scan features of tuberculosis peritonitis may help to optimize the diagnosis and management of this disease.- - - - - - - - - - ranking = 1.5keywords = tuberculosis (Clic here for more details about this article) |
4/104. Peritoneal tuberculosis: diagnostic options.BACKGROUND: Extrapulmonary tuberculosis has vague symptoms and few signs. It is essential to recognize and diagnose this curable disease prior to performing definitive surgery. Newer tests such as dna or rna amplification allow for early diagnosis but have limitations. CASE: We report a case of peritoneal tuberculosis in an immigrant woman. She had vague symptoms of low-grade fever, mild abdominal pain, obstipation, and bloating. Diagnostic laparoscopy was performed to establish the diagnosis. tuberculosis was confirmed by dna extraction from the frozen section specimen with subsequent analysis using polymerase chain reaction. CONCLUSION: Peritoneal tuberculosis is a disease that often simulates malignancies. With the increasing prevalence of human immunodeficiency virus in developed countries, tuberculosis is also on the rise and should be considered in the differential diagnosis of a patient with an abdominal/pelvic mass and ascites.- - - - - - - - - - ranking = 4keywords = tuberculosis (Clic here for more details about this article) |
5/104. Paradoxical response to anti-tuberculous drugs: resolution with corticosteroid therapy.During the course of appropriate treatment, patients with tuberculosis occasionally have unusual paradoxical reactions, with transient worsening of lesions or the development of new lesions. A 23-y-old housewife presented with abdominal tuberculosis. She was treated with anti-tuberculous agents to which the micro-organisms were susceptible. During therapy, there was an expansion of her abdominal lesions and her symptoms worsened. However, with the addition of steroids and the continuation of the same anti-tuberculous agents the patient eventually recovered completely. We emphasize that the worsening of tuberculous lesions may occur during chemotherapy and does not necessarily indicate treatment failure. This phenomenon may be immunologically based.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
6/104. Nosocomial transmission of tuberculosis (TB) associated with care of an infant with peritoneal TB.Nosocomial transmission of tuberculosis (TB) after exposure to infected peritoneal fluid has not been described. We report the exposure of 111 healthcare workers to infected dialysate from an infant with TB peritonitis. Two (5%) of 39 primary-care nurses, but no doctors or environmental service workers, had apparent tuberculin skin test conversions, raising the concern that patients with peritoneal TB may be a source for nosocomial transmission of TB.- - - - - - - - - - ranking = 2.5keywords = tuberculosis (Clic here for more details about this article) |
7/104. Tuberculous peritonitis defying diagnosis: report of a case.A case of tuberculous peritonitis, which has been scarcely encountered in clinical practice in recent years, is reported. A 32-year-old man was admitted to our hospital complaining of abdominal fullness, anorexia, and a 15 kg weight loss. His abdomen was distended. There was neither any previous history nor recent contact with tuberculosis. The laboratory data indicated increased c-reactive protein and erythrocyte sedimentation rate, but the white blood cell count was normal. A chest X-ray examination revealed no abnormalities. Abdominal X-ray showed scattered, small-intestinal gas shadows. Abdominal computed tomography scanning revealed a diffuse thickening of the dilated bowel wall, mainly adjacent to the mesentery. After a detailed examination a diagnosis of peritonitis carcinomatosa of unknown origin was suspected, and an exploratory laparotomy was done. Severe adhesions between the parietal peritoneum and the bowel were found. An excisional biopsy specimen was taken from the peritoneum, and a diagnosis of tuberculosis was thus made. Triple therapy with isoniazid, rifampicin, and kanamycin was started, and both the intestinal obstruction and anorexia were thus resolved.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
8/104. A patient presenting with a pelvic mass, elevated CA-125, and fever.BACKGROUND: Tuberculous peritonitis is a rare event which can mimic advanced stage ovarian cancer. A pelvic mass and an elevated CA-125 is suggestive of an ovarian malignancy; however, benign conditions may be discovered, especially in the premenopausal patient. CASE: A patient with a pelvic mass, ascites, and an elevated CA-125 underwent an exploratory laparotomy for presumed ovarian cancer. Final pathology revealed pelvic tuberculosis without any pulmonary involvement. Acid-fast bacilli were confirmed with polymerase chain reaction in the surgical specimen. DISCUSSION: Pelvic tuberculosis is an uncommon gynecologic condition that presents with ascites, a pelvic mass, and fever. An elevated CA-125 is not specific for ovarian malignancy.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
9/104. The great imitator: miliary peritoneal tuberculosis mimicking stage III ovarian carcinoma.PURPOSE: To report a case of peritoneal tuberculosis initially mistaken at the time of surgery for metastatic ovarian carcinoma. CASE REPORT: A 31-year-old Filipino female was found to have increasing abdominal pain, ascites, early satiety, increasing abdominal girth and bilateral complex masses. Diagnostic laparoscopy revealed the presence of > 4 liters of ascites, a frozen pelvis secondary to what appeared to be bilateral ovarian carcinomas, along with miliary seeding of the entire anterior abdominal wall, omentum, small bowel and small bowel mesentery, right and left diaphragmatic surfaces, and hepatic surface. Frozen section, at the time of laparotomy, revealed necrotizing granulomas most consistent with disseminated tuberculosis that was confirmed at the time of final pathologic review and culture. CONCLUSION: Peritoneal tuberculosis can be mistaken for widely metastatic ovarian carcinoma at time of surgery.- - - - - - - - - - ranking = 3.5keywords = tuberculosis (Clic here for more details about this article) |
10/104. Computed tomography demonstration of a fat-fluid level in tuberculous chylous ascites.The occurrence of fat-fluid levels in ascites, although rare, is pathognomic of chylous ascites. The ultrasound and CT scan findings of a fat-fluid level in the ascitic fluid of a patient with abdominal tuberculosis are described here. Recognition of this important sign, in conjunction with other ancillary findings of abdominal tuberculosis, assist in establishing the correct diagnosis. Anti-tuberculous chemotherapy suffices in treating the condition, thus obviating the need for surgical intervention.- - - - - - - - - - ranking = 1keywords = tuberculosis (Clic here for more details about this article) |
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