Nunki Andria,Rustam Siregar,Husnia Auliyatul Umma
Departement of Child Health Faculty of Medicine Sebelas Maret University Pediatric Infection and Tropical Diseases Subdivision Faculty of Medicine Sebelas Maret University
Background : Peritoneal tuberculosis is a rare disease. The peritoneum is usually infected as a result of hematogenous spread from a pulmonary focus or as a result of direct spread from adjacent organs. Infection may also result from ingesting contaminated milk or swallowing sputum in the case of active lung disease.
Case Presentation Summary : A 12 year old girl came with abdominal enlargement, reccurent fever for three weeks and decreased appetite. She has been living in the dormitory for the past year and she has no history of prolonged cough. The physical examination revealed ascites and diffused abdominal tenderness. Laboratory finding showed anemia microcytic hypochromic, neutrophilia, monocytosis, hypoalbuminemia and increased hsCRP. Chest X-Ray demonstrated blunt left costophrenicus angle. The ultrasonography revealed thickened small intestines, ascites with prominent strands of fibrin suggested for tuberculosis, mild splenomegaly and mild bilateral hydronephrosis with left pleural effusion. Abdomen MSCT revealed multiple loculated ascites including wet peritonitis, cystitis with bilateral hydroureteronephrosis, pneumonia in inferior left lobe lung with bilateral pleural effusion. Patient then underwent laparascopic biopsy showing the tubercle and necrosis in fat tissue as well as connective tissue. Antituberculosis regiments were given and in the fourth month of therapy, CT Scan was performed which demonstrated improvement.
Learning Points/Discussion : In our case, the initial presentation is consistent with reported symptoms of peritoneal tuberculosis. The combined examinations of laboratory, radiology and histology achieve accurate diagnosis so that mismanagement can be avoided.