Dimas Dwi Saputro, Rifan Fauzie, Retno Widyaningsih, Cathline Freya Adhiwidjaja
BACKGROUND. The diagnosis of abdominal tuberculosis (ATB) is difficult especially in children due to its vague clinical picture, and therefore the diagnosis is often delayed. Drug resistance is well known in pulmonary and glandular tuberculosis (TB). However, resistance in ATB is believed to be uncommon. Apart from treatment difficulties, drug resistance presents a unique challenge in ATB. OBJECTIVE. To present that an ATB manifestation may mimic a malignant process which may be primarily considered depending on initial findings CASE. A 15-year-old girl was admitted with fever, anorexia, and abdominal pain for the past three months. Presumptive diagnosis leads to malignancy. A computerized tomography (CT) examination found multiple conglomerate enlargement of lymph nodes in surrounding pancreas, mesenteric, and right-left parailiaca. Intermittent thickening appeared after contrasting in part of the intestine. Biopsy-aimed laparotomy was conducted. Laparotomy findings revealed enlargement of lymph nodes mesenteric and adnecytic invasion suggested the diagnosis of abdominal tuberculosis. Histopathological examination revealed fatty tissue pieces containing tubercles and granulation tissue with lymphocyte loops. Datia langhans cells and local necrosis were defined in granulomatous lesions as well. Rapid molecular test for tuberculosis from sputum, gastric aspirate, and feces detected mycobacterium tuberculosis with rifampicin resistance. Anti-tuberculosis drug-resistant individual regiment was started immediately. Conclusion. In tuberculosis endemic countries like Indonesia, it is important to suspect abdominal tuberculosis in patients presenting with symptoms of abdominal pain. This infectious disease can mimics malignancy, and lead to a more invasive procedure that may not be necessary.