Peritoneal Tuberculosis: Looking beyond the Typical Pathology

Peritoneal tuberculosis (TbP), an uncommon peritoneal infection, is commonly diagnosed in immigrants from developing countries and represents a substantial proportion of cases of extra pulmonary tuberculosis. The variability in patient presentation and the indolent nature of the infection, combined with limited diagnostic strategies available for TbP, often results in delayed diagnosis. Case: Described herein is the case of a 39 years old male recent immigrant from Mali (West Africa), with no significant medical history that presented to hospital with a four-day history of abdominal pain and swelling. Examination was significant for distended abdomen and shifting dullness. No signs and symptoms suggested pulmonary infection, however, QuantiFERON-TB Gold and purified protein derivative (PPD) test were positive suggesting latent Tb infection. In the absence of pulmonary tuberculosis, a diagnosis of TbP should be established histologically. Laparoscopic biopsy showed granuloma but the typical caseating granuloma of TbP was not seen. Nonetheless, based on the extent of the clinical and laboratory findings, the patient was diagnosed with TbP and anti Tb treatment ensued with successful outcome. Conclusion: The lack of caseating granulomas in the pathology should not rule out a diagnosis of TbP, especially in cases where accompanying evidence suggests some form of Tuberculosis.