A case of concurrent tuberculous pleural effusion and peritonitis

Vanya Utami Tedhy1 , Nurhidayat Mohammad1, Lie Khie Chen2, Mira Yulianti3
1Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia
2Division of Tropical Disease and Infection, Department of Internal Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
3Division of Respirology and Critical Illness, Department of Internal Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Introduction: Extrapulmonary tuberculosis accounted for about 16% of 7.5 million tuberculosis cases worldwide in 2019 with lymph nodes, pleura, and gastrointestinal system as its most common sites of infection.
Case description: A 36 year-old female patient presented with dyspnea and abdominal distention due to unilateral pleural effusion and ascites. She had accompanying symptoms of weight loss and night sweat since 6 months prior to her presentation. The patient’s medical history was unremarkable, but she had positive contact with tuberculosis patients. Diagnostic approach was taken. Both pleural fluid and ascitic fluid were analysed, revealing exudative fluid with lymphocyte predominance. ADA for both pleural and ascitic fluid was elevated. Abdominal CT scan showed para-aortic lymphadenopathy, omental thickening, and complex ascites. Pleural fluid culture for Mycobacterium was positive for M. tuberculosis. Diagnosis of tuberculous pleural effusion and peritonitis was made and anti-tuberculous treatment was initiated.
Conclusion: The variable manifestation of extrapulmonary TB can make diagnosis difficult, but this diagnosis should always be considered especially in the setting of high TB prevalence. Confirmatory diagnosis with microbiological examination should always be attempted, but clinical feature highly suspicious of TB supported with biological marker can aid in the diagnosis of extrapulmonary TB.
Keywords: tuberculous pleural effusion, tuberculous peritonitis, extrapulmonary tuberculosis

ABSTRA CT
Introduction: Extrapulmonary tuberculosis accounted for about 16% of 7.5 million tuberculosis cases worldwide in 2019 with lymph nodes, pleura, and gastrointestinal system as its most common sites of infection.
Case description: A 36 year-old female patient presented with dyspnea and abdominal distention due to unilateral pleural effusion and ascites. She had accompanying symptoms of weight loss and night sweat since 6 months prior to her presentation. The patient’s medical history was unremarkable, but she had positive contact with tuberculosis patients. Diagnostic approach was taken. Both pleural fluid and ascitic fluid were analysed, revealing exudative fluid with lymphocyte predominance. ADA for both pleural and ascitic fluid was elevated. Abdominal CT scan showed para-aortic lymphadenopathy, omental thickening, and complex ascites. Pleural fluid culture for Mycobacterium was positive for M. tuberculosis. Diagnosis of tuberculous pleural effusion and peritonitis was made and anti-tuberculous treatment was initiated.
Conclusion: The variable manifestation of extrapulmonary TB can make diagnosis difficult, but this diagnosis should always be considered especially in the setting of high TB prevalence. Confirmatory diagnosis with microbiological examination should always be attempted, but clinical feature highly suspicious of TB supported with biological marker can aid in the diagnosis of extrapulmonary TB.
Keywords: tuberculous pleural effusion, tuberculous peritonitis, extrapulmonary tuberculosis