Tuberculous Peritonitis with pleural effusion

Dr Ira Shah

doi:https://10.7199/ped.oncall.2016.7

Tuberculous Peritonitis with pleural effusion

Dr Ira Shah.

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

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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.

Compliance with ethical standards

Funding: None

Conflict of Interest: None

References

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