When Peritoneal Tuberculosis Mimics Carcinomatosis: A Diagnostic Enigma.

IF 1.6 Q4 INFECTIOUS DISEASES
International Journal of Mycobacteriology Pub Date : 2025-04-01 Epub Date: 2025-06-20 DOI:10.4103/ijmy.ijmy_19_25
Margarida Soares Resendes, Ana Paiva Santos, Daniela Meireles, Flávio G Pereira
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Abstract

Abdominal tuberculosis (TB) can present with the involvement of the peritoneum, stomach, intestinal tract, hepatobiliary tree, pancreas, perianal area, or lymph nodes. Peritoneal TB is one of the most challenging forms to diagnose and usually occurs through reactivation of latent TB infection or through hematogeneous spread in the setting of active pulmonary TB. A 25-year-old male from Guinea-Bissau, with multiple visits to the emergency department in the last month due to several daily soft stools and generalized abdominal pain. He returned with an abdominal computed tomography (CT) revealing irregular ascites and suspected peritoneal carcinomatosis. He was admitted for an etiological study, and an abdominal CT scan was repeated, which showed diffuse thickening of the stomach wall. Erythrocyte sedimentation rate of 14 mm/1 h and C-reactive protein of 1.24 mg/dL. Interferon-gamma release assay was positive. Acid-fast bacilli smear in sputum and blood and urine cultures in Loewenstein-Jensen medium were negative. Upper gastrointestinal endoscopy revealed Helicobacter Pylori infection and colonoscopy was normal. Positron emission tomography-CT confirmed the abdominal CT findings. Diagnostic laparoscopy was performed to clarify the etiology, and pathological anatomy revealed findings compatible with tuberculosis. Treatment with isoniazid, rifampicin, pyrazinamide, and ethambutolepyridoxine was started. Although abdominal TB continues to be a significant health problem in the developing world, recently, there has been an increase in the number of patients diagnosed with abdominal TB in parts of the world where TB generally was rare. This is partly a result of increasing travel and migration and also of the rising number of HIV patients who are susceptible to opportunistic infections.

当腹膜结核模拟癌:一个诊断难题。
腹部结核(TB)可累及腹膜、胃、肠道、肝胆树、胰腺、肛周区或淋巴结。腹膜结核是最具挑战性的诊断形式之一,通常通过潜伏性结核感染的再激活或通过活动性肺结核的同质传播发生。来自几内亚比绍的一名25岁男性,由于每天数次软便和全身性腹痛,上个月多次到急诊室就诊。他返回腹部计算机断层扫描(CT)显示不规则腹水和怀疑腹膜癌。他入院进行病因学研究,并重复腹部CT扫描,显示胃壁弥漫性增厚。红细胞沉降率14 mm/1 h, c反应蛋白1.24 mg/dL。干扰素释放试验阳性。痰液抗酸杆菌涂片阴性,血、尿Loewenstein-Jensen培养基培养阴性。上消化道内窥镜检查显示幽门螺杆菌感染,结肠镜检查正常。正电子发射断层扫描证实了腹部CT的表现。诊断性腹腔镜检查明确病因,病理解剖显示符合肺结核。开始使用异烟肼、利福平、吡嗪酰胺和乙胺丁醇吡哆醇治疗。虽然腹部结核在发展中国家仍然是一个重大的健康问题,但最近,在世界上结核病通常很少的地区,诊断为腹部结核的患者人数有所增加。造成这种情况的部分原因是旅行和移徙的增加,以及易受机会性感染的艾滋病毒患者人数的增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.20
自引率
25.00%
发文量
62
审稿时长
7 weeks
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