A case report of tuberculous peritonitis that was difficult to differentiate from peritonitis carcinomatosa

DOI Web Site 3 Citations
  • WAKINOUE Shiro
    Department of Obstetrics and Gynecology, Ijinkai-Takeda General Hospital
  • KASAHARA Kyoko
    Department of Obstetrics and Gynecology, Ijinkai-Takeda General Hospital
  • YAMAMOTO Yoshiaki
    Department of Obstetrics and Gynecology, Ijinkai-Takeda General Hospital
  • NAGATA Norikazu
    Department of Pathology, Ijinkai-Takeda General Hospital

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  • 癌性腹膜炎との鑑別が困難であった結核性腹膜炎の1例
  • 症例報告 癌性腹膜炎との鑑別が困難であった結核性腹膜炎の1例
  • ショウレイ ホウコク ガンセイ フクマクエン トノ カンベツ ガ コンナン デ アッタ ケッカクセイ フクマクエン ノ 1レイ

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Abstract

Tuberculous peritonitis is an extrapulmonary tuberculosis, which is a rare disease occupying 0.04∼0.6 % of all types of tuberculosis. Recently, we encountered a case of tuberculous peritonitis, which was differentiated from peritonitis carcinomatosa by histological diagnosis. The patient was a 62-year-old woman (Para IV) who consulted our hospital with chief complains of lower abdominal pain and constipation. Ultrasonography and CT demonstrated ascites. Cytodiagnosis of ascites was negative, but hyaluronic acid and the activity of adenosine deaminase (ADA) in ascites were increased. In addition, serum CA125 was increased to 155.1 U/ml. However, inflammatory findings were slight and the general conditions were also good. Image examinations using CT, MRI and PET-CT demonstrated thickening of the peritoneum and the body of the stomach, and nodules in the mesenteric lymph nodes. Based on these findings, tuberculous peritonitis was initially suspected, but PCR showed that ascites was negative for mycobacterium tuberculosis. Therefore, it became necessary to differentiate this disease from peritonitis carcinomatosa, malignant lymphoma and mesotheliomas. Since it was difficult to establish a definitive diagnosis, laparoscopic biopsy of the peritoneum was performed. Laparoscopy demonstrated that the parietal side of the peritoneum closely adhered to the greater omentum and intestine. Furthermore, a large number of yellow nodules were diffused in the parietal and visceral sides of peritoneum. Based on rapid perioperative histopathological diagnosis, the patient was diagnosed as having tuberculous peritonitis. Then, 4-drug combination therapy (rifampicin, isoniazid, pyradinamide and ethanbutol) was started. As a result, both pleural effusion and ascites disappeared and the serum CA125 was lowered. When the patient demonstrates ascites and peritoneal thickening of unknown origin, physicians should perform a histological examination to differentiate between peritonitis carcinomatosa and tuberculous peritonitis. [Adv Obstet Gynecol,59 (3):244-248,2007 (H19.8)]<br>

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