Volume 2018, Article ID 2318539, 2 pages https://doi.org/10.1155/2018/2318539
Case Report A Rare Culprit of Spontaneous Abortion, Latent Tuberculosis Complicated by Disseminated Peritoneal TB
Christoph Sossou ,1 Chaitanya Pal,1 and Jose R. Bustillo2
1 Resident Physician, Internal Medicine, Newark Beth Medical Center, Department of Medicine, Newark, NJ, USA 2 Associate Residency Program Director, Newark Beth Medical Center, Department of Medicine, Newark, NJ, USA
Correspondence should be addressed to Christoph Sossou; [email protected]
Received 15 July 2018; Accepted 11 October 2018; Published 28 October 2018
1. Case Introduction pleural effusion, low-grade fever, progressive worsening
abdominal pain, and spontaneous abortion. Non-contrast- Medical awareness of peritoneal tuberculosis (TB) is still enhanced computed tomography of the chest (Figure 1) lacking, and many women with this disease are initially revealed large right-sided pleural effusion, and contrast- thought to have ovarian neoplasm [1] and undergo un- enhanced computed tomography of the abdomen and necessary extensive workup and, at times, invasive sur- pelvis (Figure 2) revealed bilateral hilar adenopathy, ascites, gical procedures [2]. Gastrointestinal extrapulmonary thickening and enhancement of the peritoneum, and mot- tuberculosis (TB) is extremely rare [1], and its association tled nodular-appearing soft tissue consistent with omental with miscarriages has rarely been reported in the litera- caking suspicious for peritoneal carcinomatosis. She un- ture. This is a case of a 38-year-old Liberian female with derwent extensive workup including surgical and oncologist untreated latent TB who subsequently developed dis- consultations for possible exploratory laparotomy and dis- seminated peritoneal tuberculosis, complicated by spon- cussion of treatment options for presumed ovarian neo- taneous abortion. plasm. Blood work revealed elevated carbohydrate antigen (CA) 125 and positive QuantiFERON-TB Gold, but aden- 2. Case Description osine deaminase, CA 19, alpha-fetoprotein, and inhibin B were within normal limits. Diagnostic laparoscopy with A 38-year-old Liberian female with a 12-week gestation biopsy revealed significant pelvis ascites and diffuse miliary presented to the emergency department with a 3-week lesions throughout the peritoneum. She underwent di- history of low-grade subjective fever, night sweats, un- latation and curettage; histopathologic examination showed intentional weight loss, gradually worsening abdominal chronic granulomatous inflammation with no evidence of pain, and intermittent spotting. Vital signs were stable on neoplasm. Special stains on tissue sections and ascitic fluid presentation, physical exam noticeable for gravida abdomen, stain revealed rare acid-fast bacilli, suggestive of mycobac- otherwise unremarkable. Laboratory examination revealed terial granulomatous peritonitis. Additional questioning beta hCG 118471, which was otherwise unremarkable. Pelvic indicated a history of positive PPD skin test a year prior ultrasound confirmed a 12-week viable intrauterine preg- without follow-up treatment. The patient was placed on nancy. The patient was admitted to the hospital for close four-drug anti-tuberculous therapy and had a complete monitoring. Hospital course was complicated by massive recovery. 2 Case Reports in Infectious Diseases
Figure 1: Computed tomography of the chest without contrast. Moderate right pleural effusion with passive atelectasis of the right middle and lower lobes; bilateral hilar lymphadenopathy; perihepatic ascites.
(a) (b)
Figure 2: Computed tomography of the abdomen and pelvis with contrast. Diffuse mesenteric enhancement in the left upper quadrant suspicious for carcinomatosis (a) and multiloculated cystic mass adjacent to the right adnexa suspicious for ovarian neoplasm (b).
3. Case Discussion Conflicts of Interest
Gastrointestinal extrapulmonary TB is extremely un- The authors declare that they have no conflicts of interest. common [2]. Clinical manifestations are nonspecific and protean, but fever, abdominal pain, night sweats, anorexia, References weight loss, pleural effusions, and ascites should raise the suspicion of tuberculous peritonitis especially in a patient [1] J. B. Sharma, S. K. Jain, M. Pushparag et al., “Abdomi- no—peritoneal tuberculosis masquerading as ovarian cancer: such as the one in this case report from an endemic area. This a retrospective study of 26 cases,” Archives of Gynecology and is a unique case as it is the first known case in the literature of Obstetrics, vol. 282, no. 6, pp. 643–648, 2010. disseminated peritoneal TB complicated by spontaneous [2] S. Koc, G. Beydilli, G. Tulunay et al., “Peritoneal tuberculosis abortion in a patient with history of latent TB. This case mimicking advanced ovarian cancer: a retrospective review of raises the vital question of how we should proceed with 22 cases,” Gynecologic Oncology, vol. 103, no. 2, pp. 565–569, management of latent TB in women of reproductive age. 2006. Our case presents three important points. First, medical [3] D. L. Kasper, A. S. Fauci, S. L. Hauser, D. L. Longo, J. Jameson, awareness of peritoneal TB is lacking [3]. Second, routine and J. Loscalzo, Harrison’s Principle of Internal Medicine, diagnostic methods such as direct acid-fast bacilli smear and McGraw-Hill, Vol. 19e, McGraw-Hill, New York, NY, USA, cultures are of relatively low diagnostic yield in peritoneal 2015. TB [3]. Finally, laparoscopy with biopsies is a safe and ef- [4] F. M. Sanai and K. I. Bzeizi, “Systematic review: tuberculous peritonitis–presenting features, diagnostic strategies and fective method to diagnose peritoneal tuberculosis [4, 5]. treatment,” Alimentary Pharmacology and Therapeutics, Early diagnosis would aid in avoidance of unnecessary ex- vol. 22, no. 8, pp. 685–700, 2005. tensive workup and surgery, permitting prompt initiation of [5] D. K. B. Shriniwas, P. Chopra, S. Nijhawan, S. Dasarathy, and appropriate therapy. This would shorten hospital length-of- A. K. Kushwaha, “Peritoneal tuberculosis: laparoscopic pat- stay, reduce resource utilization, and increase overall pa- terns and its diagnostic accuracy,” American Journal of Gas- tients’ satisfaction. troenterology, vol. 87, no. 1, pp. 109–112, 1992.
