Grand Rounds

Tuberculous Peritonitis with pleural effusion

Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056

Clinical Problem :
A 12 years old girl presented with fever and abdominal distension. There was no contact with TB. She was detected to have left sided pleural effusion with ascites. Chest X-Ray showed left pleural effusion with hilar adenopathy. USG abdomen showed mild hepatosplenomegaly with moderate ascites. Mantoux test was negative. Hemoglobin was 10.3 gm, dl, white cell count was 5100, cumm {88 percent polymorphs, 12 percent lymphocytes}, ESR was 60 mm at end of 1 hour. Ascitic tap showed 4.8 gm percent proteins, 480 cells {2 percent polymorphs, 98 percent lymphocytes} and ADA-151 µ, L. ANA, dsDNA was negative. Child was started on 4 drugs ATT with steroids. Steroids were stopped after 2 months and ATT was stopped after 9 months. At that time Chest X-Ray was normal. She had gained 7 kg in the same time.

Is tuberculous peritonitis associated commonly with pleural effusion_?

Discussion :
Tuberculous peritonitis results from hematogenous spread or contagious spread by reactivation of latent foci from an abdominal focus or mesenteric lymph node. It is an uncommon presentation of tuberculosis {TB} especially in children without any other debilitating disease such as cirrhosis, diabetes and chronic renal failure on continuous ambulatory peritoneal dialysis. Chest radiographs are abnormal in 50-75 percent of patients with tuberculous peritonitis and commonly associated with pleural effusion. {1-4} Ascites causing a marked increase in abdominal pressure and the fluid might move into the thoracic cavity with an unknown mechanism, and the removal of ascites might be needed to prevent this phenomenon. {5} Thus co-existing pleural effusion in patients with tuberculous peritonitis is not uncommon.

References :
  1. Dinler G, Sensoy G, Helek D, Kalayci AG. Tuberculous peritonitis in children: report of nine patients and review of the literature. World J Gastroenterol. 2008;14:7235-7239
  2. Tanrikulu AC, Aldemir M, Gurkan F, Suner A, Dagli CE, Ece A. Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey. J Gastroenterol Hepatol. 2005;20:906–909.
  3. Wang HK, Hsueh PR, Hung CC, Chang SC, Luh KT, Hsieh WC. Tuberculous peritonitis: analysis of 35 cases. J Microbiol Immunol Infect. 1998;31:113–118.
  4. Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma: abdominal tuberculosis. World J Gastroenterol. 2003;9:1098–1101.
  5. Taniguchi H, Izumi S. A case of tuberculous peritonitis showing a rapid increase of bilateral pleural effusion. Kekkaku. 2005; 80: 15-18

Correct Answers :  yes 100%
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