title: Discovering the elusive underlying cause of a bilateral effusion combined with ascites.
abstract: A 77-year-old Asian man presented to the emergency department with bilateral pleural effusion and ascites accompanied with generalized weakness, dyspnea, tachycardia, and tachypnea. After an extensive workup that ruled out heart failure, pulmonary embolism, pneumonia, and malignancy-including extensive laboratory tests, electrocardiograms, chest x-ray, computed tomographic angiogram, computed tomography scans of the abdomen and pelvis, colonoscopy, thoracentesis, paracentesis, and exploratory laparoscopy-an elusive peritoneal tuberculosis was successfully identified. This case suggests that clinicians should consider extrapulmonary tuberculosis in their practice, given increasing immigration and the variety of populations present in our society. When tuberculosis is suspected, a negative smear for acid-fast bacillus, a lack of granulomas on histopathology, and failure to culture Mycobacterium tuberculosis do not exclude the diagnosis. Exploratory laparoscopy or minilaparotomy has a high level of sensitivity and specificity so should be considered.
authors.affiliation: Baylor Medical Center at Garland, Garland, Texas, USA. jzhangxxt@yahoo.com
authors.forename: Jinsong
authors.initials: J
authors.lastname: Zhang
authors.forename: Leslie
authors.initials: L
authors.lastname: Tingle
authors.forename: Raji
authors.initials: R
authors.lastname: Nair
authors.forename: John
authors.initials: J
authors.lastname: Mercer
authors.forename: Walter
authors.initials: W
authors.lastname: Johnston
authors.forename: Cyrus
authors.initials: C
authors.lastname: Lambert
authors.forename: Mark
authors.initials: M
authors.lastname: Miller
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Tummala
authors.forename: William
authors.initials: W
authors.lastname: Winn
authors.forename: Franklin
authors.initials: F
authors.lastname: Yau
authors.forename: Walt
authors.initials: W
authors.lastname: Simons
authors.forename: Dan
authors.initials: D
authors.lastname: Molina