Ruiz Jose, Ganji Maedeh, Canha Catarina, Isache Carmen
University of Florida-COM, Division of Internal Medicine, Jacksonville, FL, USA.
Case Rep Infect Dis. 2018 Oct 23;2018:8136476. doi: 10.1155/2018/8136476. eCollection 2018.
Approximately 2 billion people, which is about one third of the world's population, are infected with tuberculosis (TB). Around 10% of infected people will develop active TB at one point in their lifetime. We present a rare case of a 68-year-old male who presented to the emergency department with a 2-week progressive dyspnea. In addition, the patient complained of generalized weakness, subjective fevers, and abdominal pain in the right upper quadrant. Ascites was noted on physical exam, and the patient underwent a diagnostic paracentesis with initial workup that was unrevealing for underlying etiology. Abdominal computed tomography was done, which revealed peritoneal carcinomatosis. He underwent omental biopsy which showed necrotizing granulomatous inflammation with rare acid-fast bacilli. Repeat biopsy was culture positive for mycobacterium tuberculosis complex. The patient was started on rifampin, isoniazid, pyrazinamide, and ethambutol with improvement of his symptoms days after treatment was started. This case demonstrates how the diagnosis of peritoneal tuberculosis can be elusive. Physicians must be aware of this disease and its behavior in high risk patients, also of the current diagnostic limitations.
约20亿人感染了结核病（TB），占世界人口的三分之一左右。约10%的感染者在其一生中的某个时候会发展为活动性结核病。我们报告一例罕见病例，一名68岁男性因进行性呼吸困难2周就诊于急诊科。此外，患者主诉全身无力、自觉发热及右上腹腹痛。体格检查发现腹水，患者接受了诊断性腹腔穿刺术，初步检查未发现潜在病因。进行了腹部计算机断层扫描，结果显示为腹膜癌。他接受了网膜活检，结果显示为坏死性肉芽肿性炎症，罕见抗酸杆菌。重复活检结核分枝杆菌复合群培养呈阳性。患者开始使用利福平、异烟肼、吡嗪酰胺和乙胺丁醇治疗，治疗开始数天后症状有所改善。该病例表明腹膜结核的诊断可能很困难。医生必须了解这种疾病及其在高危患者中的表现，也要了解目前的诊断局限性。
