title: Tuberculous peritonitis--reports of 26 cases, detailing diagnostic and therapeutic problems.
abstract: OBJECTIVE
  To evaluate the clinical presentation, biochemical (ascites and serum) and laparoscopic findings, and to assess the efficacy of triple antituberculous therapy without rifampicin for 6 months in patients with tuberculous peritonitis.
  
  
  METHODS
  Twenty-six tuberculous peritonitis patients (11 male, 15 female) with a mean age of 34.8 +/- 3.4 years (range 14-77) were assessed with regard to diagnostic and therapeutic features.
  
  
  RESULTS
  The most common symptoms and signs were abdominal pain (92.3%) and ascites (96.2%), respectively. Tuberculin skin test (TST) was positive in all patients. An abnormal chest radiography suggestive of previous tuberculosis was present in five patients (19.2%), and two patients (7.7%) had extra-peritoneal (cerebral, pericardial) active tuberculous involvement. In 24 of the 25 patients who underwent laparoscopy with directed biopsy, whitish nodules suggested tuberculous peritonitis; 76% of the biopsy specimens revealed caseating, 20% non-caseating granulomatous inflammation, and 4% non-specific findings. The ascitic fluid of one patient (3.8%) was positive for acid-resistant bacilli, and culture was positive in two patients (7.7%). Twenty-four of the patients were treated for 6 months with isoniazid, streptomycin (total dose 40 g) and pyrazinamide (for the first 2 months and then substituted with ethambutol). Eighteen patients also received methyl prednisolone, initially 20 mg/day, for 1 month. The follow-up period was 19 +/- 1.7 months after the end of therapy (range 6-36). Ascites and abdominal pain abated earlier in patients on steroid therapy. All but two of the 24 patients responded to treatment.
  
  
  CONCLUSIONS
  Non-invasive tests such as acid-fast stain and culture of the ascitic fluid are usually insufficient, hence invasive laparoscopy and peritoneal biopsy are necessary for the diagnosis of tuberculous peritonitis if non-invasive tests such as ascites adenosine deaminase activity measurement are not easily available. Triple therapy without rifampicin for 6 months is sufficient to treat tuberculous peritonitis.
authors.affiliation: Department of Internal Medicine, Istanbul Medical Faculty, Turkey. kadirdr@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Demir
authors.forename: A
authors.initials: A
authors.lastname: Okten
authors.forename: S
authors.initials: S
authors.lastname: Kaymakoglu
authors.forename: D
authors.initials: D
authors.lastname: Dincer
authors.forename: F
authors.initials: F
authors.lastname: Besisik
authors.forename: U
authors.initials: U
authors.lastname: Cevikbas
authors.forename: S
authors.initials: S
authors.lastname: Ozdil
authors.forename: G
authors.initials: G
authors.lastname: Bostas
authors.forename: Z
authors.initials: Z
authors.lastname: Mungan
authors.forename: Y
authors.initials: Y
authors.lastname: Cakaloglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001706:Biopsy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000473:pathology; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014374:Tuberculin Test
chemical_list: D000900:Anti-Bacterial Agents