Tuberculous peritonitis.

Tuberculous peritonitis is an uncommon disorder and is often not considered on initial evaluation of ascites. A negative 5-TU PPD test, a normal chest roentgenogram, or a low level of ascitic fluid protein may erroneously direct attention away from tuberculosis. Failure to thoroughly evaluate nonmalignant exudative ascites, especially in alcoholics, is a common diagnostic pitfall. TB peritonitis should be considered in the differential diagnosis in every patient who presents with ascites, fever, and abdominal pain, particularly when alcoholism, a lung lesion, weight loss, or cirrhosis is also present. Percutaneous needle biopsy of peritoneum, followed by peritoneoscopy if necessary, may preclude the need for laparotomy. Antituberculous drugs, when conscientiously taken, afford a rapid response with a cure in most patients. Case material on four patients is presented.