SESSION TITLE: Infectious Disease Student/Resident Case Report Posters III
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: There were 9945 new cases of TB in the United States in 2012 with an incidence rate of 3.2 per 100000 populations. Among these 63% are foreign born. Tuberculosis, especially extra-pulmonary tuberculosis, is known to present with illusive findings. Rates of extra-pulmonary tuberculosis continue to rising even asthe incidence of HIV is decreasing. We present a case of extra-pulmonary tuberculosis which was initially misdiagnosed because of its unusual abdominal presentation.
CASE PRESENTATION: A 73 year-old Laotian female presented with vague abdominal pain, ascites, pleural effusion, night sweats and chills without fever. Her medical history was insignificant and she was on no medications. Physical examination was unremarkable except for diffuse abdominal tenderness in the left lower quadrant. An abdominal mass was intermittently palpable. Laboratory data were unremarkable. Chest radiographs demonstrated a right pleural effusion. Computed tomography scan of abdomen and pelvis documented cholelithiasis and small amount of ascites. She was treated symptomatically before discharged. Three months later she complained of dyspnea, fatigue and weight loss. Intermittent fever chills and night sweats continued. The pleural effusion had increased. Repeat abdominal scan documented ascites and a peritoneal mass in left lower quadrant and Meigs’ syndrome was suspected. She underwent thoracentesis and paracentesis. Acid fast bacilli stains were negative. Serum CA-125 was elevated. Laparoscopy with peritoneal biopsy and left salpingooophorectomy was performed.She subsequently underwent a thoracotomy with pleural biopsy.The peritoneal biopsy demonstrated predominance of lymphocytes and non-necrotizing granulomatous inflammation. Pleural, peritoneal and ovarian biopsy cultures grew Mycobacterium tuberculosis. She is doing well with appropriate anti-tubercular treatment.
DISCUSSION: Abdominal tuberculosis can present with symptoms mimicking advanced ovarian pathology, leading to unnecessary surgical procedures. Diagnosis of abdominal tuberculosis requires high index of suspicion, especially in immigrants. Abdominal tuberculosis can be fatal if left untreated and can be cured if a timely diagnosis is established.
CONCLUSIONS: This case highlights the importance for clinicians to maintain high index of suspicion for extra-pulmonary tuberculosis especially in immigrant females who present with signs and symptoms mimicking ovarian pathology.
Reference #1: World J Gastroenterol. 2006 Oct 21;12(39):6371-5. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. Khan R1, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z.
DISCLOSURE: The following authors have nothing to disclose: Fagunkumar Modi, Disha Awasthi, Gaurav Shah, Frederick Clayton, Jayantilal Mehta, Ryland Byrd,Jr., Thomas Roy
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