Menke Jan, Kühnle Ingrid
Department of Diagnostic Radiology, University Hospital, Robert-Koch-Strasse 40, 37075, Goettingen, Germany,
Infection. 2014 Apr;42(2):415-8. doi: 10.1007/s15010-013-0521-0. Epub 2013 Aug 17.
A 13-year-old girl with weight loss and ascites was admitted with suspicion of a malignant disease. Abdominal magnetic resonance imaging indicated extensive peritonitis and showed no evidence of a solid tumor. As a new imaging observation, thoracic computed tomography showed a lymphoma-like infracarinal mass and further enlarged lymph nodes in the pathway of draining lymph ducts. A tuberculin skin test and an interferon-gamma blood test were positive, and the tumor marker CA-125 was elevated. Histology of a peritoneal biopsy showed infectious granulomas with central necrosis, and Mycobacterium tuberculosis could be cultured, leading to the diagnosis of a tuberculous peritonitis. The girl received multi-drug anti-tuberculous treatment and subsequently recovered. At follow-up the peritonitis and the infracarinal mass had vanished. In conclusion, tuberculous peritonitis is a rare but relevant differential diagnosis in peritonitis of unknown origin. Its diagnosis is facilitated by imaging, by tuberculosis skin and blood tests, and by clinical interpretation.
一名13岁体重减轻且伴有腹水的女孩因疑似患有恶性疾病而入院。腹部磁共振成像显示广泛的腹膜炎，未发现实体瘤迹象。作为一项新的影像学观察结果，胸部计算机断层扫描显示隆突下有一个淋巴瘤样肿块，且引流淋巴管走行区域的淋巴结进一步肿大。结核菌素皮肤试验和干扰素-γ血液检测呈阳性，肿瘤标志物CA-125升高。腹膜活检组织学检查显示有中央坏死的感染性肉芽肿，可培养出结核分枝杆菌，从而诊断为结核性腹膜炎。该女孩接受了多药抗结核治疗，随后康复。随访时腹膜炎和隆突下肿块均已消失。总之，结核性腹膜炎在不明原因的腹膜炎中是一种罕见但相关的鉴别诊断。影像学检查、结核菌素皮肤及血液检测以及临床解读有助于其诊断。
