Peritoneal tuberculosis in a 15-month-old male: surgical diagnosis of an insidious disease.
BACKGROUND
Peritoneal involvement is a relatively rare complication of tuberculosis, accounting for approximately 3.3% of extrapulmonary disease in the United States. Clinical diagnosis relies on a preponderance of indirect evidence and is often delayed. We describe such a patient.


METHODS
An otherwise healthy 15-month-old male presented with fever, abdominal distention, vague abdominal pains, and a few episodes of watery diarrhea. Standard laboratory and radiologic work-up was unrevealing, and after a prolonged hospitalization, caseating granulomas were identified at diagnostic laparotomy.


RESULTS
Definitive treatment was further delayed pending culture results, and the patient's condition worsened until fulminant cardiovascular collapse led to his demise.


CONCLUSIONS
Despite effective chemotherapeutic regimens, the overall mortality of tuberculous peritonitis may be as high as 51%. The diagnosis must be considered and empiric antituberculous treatment started early in the course of the disease, even if definitive diagnosis is still pending.
Katigbak
Mario W
MW
Department of Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA.
Shlasko
Edward
E
Klein
Scott M
SM
Calaman
Sharon
S
D000995:Antitubercular Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology / Q000628:therapy; D003951:Diagnostic Errors; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D019152:Paracentesis / Q000009:adverse effects*; D014395:Peritonitis, Tuberculous / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013514:Surgical Procedures, Operative
D000995:Antitubercular Agents