title: Two cases of tuberculous peritonitis with liver cirrhosis complicated by refractory ascites.
abstract: We present two cases of tuberculous peritonitis with liver cirrhosis complicated by refractory ascites. Case 1 was a 59-year-old female with alcoholic liver cirrhosis. She was admitted to our hospital because of diarrhea, anorexia and inflammatory reactions on a blood test. She had a high fever of 38°C or more and refractory ascites. Tubercle bacilli infection was suspected based on increased levels of serum CA125 and adenosine deaminase (ADA) in ascites. Laparoscopic examination showed white nodules on the peritoneum, and histologic study confirmed tuberculous nodules. The same bacteria were isolated from culture of ascites. Case 2 was a 55-year-old female with hepatitis C virus-infected liver cirrhosis. She was admitted because of high fever and abdominal fullness due to ascites. High levels of serum CA125 and ADA in ascites and ineffectiveness of treatment with antibiotics plus diuretics led us to start anti-tuberculous therapy before definitive diagnosis. Tuberculus bacillus was later isolated from culture of ascites. It is difficult to make early diagnosis of tuberculous peritonitis in cirrhotic patients with ascites due to a lack of specific symptoms. However, determination of serum CA125 and ADA in ascites and the acid-fast bacterial culture of ascites are useful for early diagnosis.
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Yuu
authors.initials: Y
authors.lastname: Shimozuma
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan. tito@med.showa-u.ac.jp.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Ishii
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Inokuchi
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Uchikoshi
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Oyama
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Hiroishi
authors.affiliation: Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8666, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Imawari
keywords: CA125 and adenosine deaminase; Liver cirrhosis; Refractory ascites; Tuberculous peritonitis