title: A 33-year-old Haitian immigrant with 7 months of abdominal pain and progressive distension.
abstract: We report a case of a 33-year-old previously healthy Haitian immigrant with a 7-month history of abdominal pain, fever and ascites. He had a history of positive tuberculin skin test but never underwent treatment for latent tuberculosis (TB) infection. Initial examination showed abdominal distension. Abdominal CT scan showed mild ascites, abnormal soft tissue in the greater omentum and small bowel mesentery, retroperitoneal adenopathy, peritoneal thickening and dilated loops of small bowel. Paracentesis and thoracentesis were initially non-diagnostic. HIV testing was negative. The differential diagnosis included lymphoma and TB peritonitis. The omental mass was biopsied under ultrasound guidance, and histopathology revealed non-necrotising granulomas. Sputum cultures and omental biopsy cultures subsequently grew Mycobacterium tuberculosis, and a diagnosis was made of pulmonary TB with TB peritonitis. The patient responded well to the initiation of anti-TB treatment.
authors.affiliation: Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA.
authors.forename: Shelli
authors.initials: S
authors.lastname: Farhadian
authors.affiliation: Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Sheela V
authors.initials: SV
authors.lastname: Shenoi
authors.affiliation: Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Merceditas S
authors.initials: MS
authors.lastname: Villanueva
mesh_terms: D000005:Abdomen / Q000382:microbiology / Q000473:pathology*; D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001201:Ascites / Q000175:diagnosis / Q000209:etiology; D001706:Biopsy; D003937:Diagnosis, Differential; D054242:Emigrants and Immigrants; D006099:Granuloma / Q000473:pathology; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis; D009852:Omentum / Q000382:microbiology / Q000473:pathology*; D014395:Peritonitis, Tuberculous / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D013183:Sputum / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology
chemical_list: D000995:Antitubercular Agents