Obstet Gynecol Sci.  2017 Mar;60(2):218-222. 10.5468/ogs.2017.60.2.218.

Tuberculous peritonitis in the first trimester of pregnancy

• Jung S
• Yun NR
• Kim JO
• Lee JH
• Kim HY
• Song E
• Lee BI
• Hwang SO
• Choi SR

• KMID: 2372808
• DOI: http://doi.org/10.5468/ogs.2017.60.2.218

Abstract

Tuberculous peritonitis in pregnancy is a rare form of extrapulmonary tuberculosis that is not easily diagnosed. The clinical presentations of tuberculous peritonitis are usually non-specific and mimic those of other diseases, such as ovarian malignancy or chronic liver disease, and this non-specificity can cause diagnostic delays and complications. The authors report the case of a 31-year-old primigravida woman who presented with uncontrolled fever, dyspnea, elevated liver enzymes, and mild abdominal distension at 13+2 weeks of gestation. At 14+2 weeks, a therapeutic abortion was conducted and tuberculous peritonitis was confirmed by laparoscopic excisional biopsy of peritoneal nodules and histopathologic examination. The patient recovered on antituberculosis therapy and abdomen and chest follow up radiographic findings have confirmed improvement.

Keyword

Peritonitis; tuberculous; Pregnancy

MeSH Terms

Abdomen
Abortion, Therapeutic
Adult
Biopsy
Dyspnea
Female
Fever
Follow-Up Studies
Humans
Liver
Liver Diseases
Peritonitis
Peritonitis, Tuberculous*
Pregnancy
Pregnancy Trimester, First*
Pregnancy*
Thorax
Tuberculosis

Figure

• 

  Fig. 1 (A) Chest computed tomography image showing diffuse miliary nodules and ground glass opacity patterns in both lungs. (B) An abdominopelvic computed tomography image showing large amount of ascites and omental fatty infiltration.

• 

  Fig. 2 Peritoneal laparoscopic findings. (A) Anterior peritoneal wall showing yellow-white multiple peritoneal nodules. (B) Liver surface with a yellow-white adhesive band. (C,D) Pelvic cavity showing severe adhesions with yellow-white threads and bands, and inflammatory changes on fallopian tube. Histopathologic examinations. (E) Peritoneal nodule showing well-defined chronic granulomatous inflammation and caseous necrosis (H&E, ×10). (F) A round granuloma containing central caseous necrosis, multinucleated giant cells and recognizable neutrophils (H&E, ×40).

Reference

1. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis: presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005; 22:685–700.

2. Lahbabi M, Brini J, Massaoudi K. Tuberculous peritonitis in pregnancy: a case report. J Med Case Rep. 2014; 8:3.

3. Ard KL, Chan BT, Milner DA Jr, Farmer PE, Koenig SP. Peritoneal tuberculosis in a pregnant woman from Haiti, United States. Emerg Infect Dis. 2013; 19:514–516.

4. Alaoui FZ, Rachad M, Chaara H, Bouguern H, Melhouf MA. Peritoneal tuberculosis in pregnancy: a case report. Pan Afr Med J. 2012; 12:65.

5. Sakorafas GH, Ntavatzikos A, Konstantiadou I, Karamitopoulou E, Kavatha D, Peros G. Peritoneal tuberculosis in pregnancy mimicking advanced ovarian cancer: a plea to avoid hasty, radical and irreversible surgical decisions. Int J Infect Dis. 2009; 13:e270–e272.

6. Lee GS, Kim SJ, Park IY, Shin JC, Kim SP. Tuberculous peritonitis in pregnancy. J Obstet Gynaecol Res. 2005; 31:436–438.

7. Koc S, Beydilli G, Tulunay G, Ocalan R, Boran N, Ozgul N, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol. 2006; 103:565–569.

8. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993; 88:989–999.

9. Avcu G, Sensoy G, Karli A, Caltepe G, Sullu Y, Belet N, et al. A case of tuberculous peritonitis in childhood. J Infect Public Health. 2015; 8:369–372.

10. Dwivedi M, Misra SP, Misra V, Kumar R. Value of adenosine deaminase estimation in the diagnosis of tuberculous ascites. Am J Gastroenterol. 1990; 85:1123–1125.