Zayn Al-Timimi, Gem Chew, Martin Browne, Christiaan Mostert
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Abstract
We report the case of a 34-year-old male with persistent fever, ascites, thrombocytosis and clinical deterioration despite broad-spectrum therapy who was ultimately diagnosed with peritoneal tuberculosis and concurrent chronic myeloid leukaemia. Initial investigations, including interferon-γ release assay and ascitic acid-fast bacilli, were negative, highlighting the limited sensitivity of traditional testing in extrapulmonary disease. Diagnosis required molecular testing and adenosine deaminase measurement, with delayed confirmation by culture. Bone marrow aspirate and trephine, pursued to broaden the differential diagnosis, revealed a Philadelphia chromosome. This case underscores the need for sustained diagnostic vigilance, multimodal investigation and avoidance of diagnostic parsimony.
期刊介绍：
The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
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