title: Laparoscopic peritoneal biopsy can be crucial for diagnosis of tuberculous peritonitis.
abstract: A 28-year-old woman was admitted to a nearby hospital because of low-grade fever and lower abdominal pain, where ascites and slightly elevated serum CA125 level were found. Both acid-fast stain (AFS) and polymerase chain reaction (PCR) failed to detect Mycobacterium tuberculosis in her ascitic fluid, sputum, and gastric juice. She was referred to our division under suspicion of tuberculous peritonitis or ovarian carcinoma. Finally, diagnostic laparoscopy was carried out, showing yellowish-white small nodules disseminated on her whole peritoneum with thin fibrous adhesions. Peritoneal biopsy of these nodules showed epithelioid cell granulomas without caseous necrosis. AFS and PCR again failed to show any evidence of Mycobacterium tuberculosis in these biopsied samples. Based on the laparoscopic findings, however, we thought that she suffered from tuberculous peritonitis. Antituberculous therapy was started and she improved soon. Later, Mycobacterium tuberculosis was demonstrated in the 4-week culture of a peritoneal biopsy specimen. We conclude that laparoscopy may be the only way to detect Mycobacterium tuberculosis in tuberculous peritonitis whenever doubtful but no direct evidence is obtained.
authors.affiliation: The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan. miuratom@nagaoka.jrc.or.jp.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Miura
authors.affiliation: The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Nakamura
authors.affiliation: The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.affiliation: The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Miura
authors.affiliation: The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yanagi
authors.affiliation: The Division of Infectious Diseases, Nagaoka Red Cross Hospital, Nagaoka, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Nishibori
authors.affiliation: The Division of Gastroenterology, Joetsu General Hospital, Joetsu, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takei
authors.affiliation: The Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takahashi
keywords: Adenosine deaminase; CA125; Laparoscopy; Tuberculous peritonitis