title: Tuberculous peritonitis during pegylated interferon plus ribavirin combination therapy in a patient with chronic hepatitis C.
abstract: A woman in her 70s with fever and abdominal distension was referred to our hospital for investigation. She had just finished a course of pegylated interferon and ribavirin combination therapy for chronic hepatitis C. Abdominal computed tomography revealed peritoneal thickening and ascites. QuantiFERON(®)-TB Gold was positive, ascitic adenosine deaminase was high, and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed diffuse accumulation in the peritoneum. Although these findings suggested tuberculous peritonitis, we did not detect Mycobacterium tuberculosis in any bacterial cultures, ascites, or other specimens. However, laparoscopic peritoneal biopsy demonstrated a large number of miliary white nodules in the parietal and visceral peritonea. Pathological examination of these nodules revealed epidermoid granuloma with giant Langhans' cells and caseous necrosis. Finally, the diagnosed of tuberculous peritonitis was established. It is important to consider tuberculosis in patients presenting with new symptoms while receiving interferon therapy.
authors.affiliation: Center for Postgraduate Training, Nara Medical University.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Fukuba
authors.forename: Hideto
authors.initials: H
authors.lastname: Kawaratani
authors.forename: Takuya
authors.initials: T
authors.lastname: Kubo
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kaya
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Aihara
authors.forename: Chie
authors.initials: C
authors.lastname: Morioka
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Noguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Mitoro
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshiji
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukui
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects* / Q000627:therapeutic use; D064847:Multimodal Imaging; D014395:Peritonitis, Tuberculous / Q000188:drug therapy / Q000209:etiology*; D049268:Positron-Emission Tomography; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000995:Antitubercular Agents; D004338:Drug Combinations; D012254:Ribavirin; D007372:Interferons