title: Co-existing tuberculosis and malignant mesothelioma with multiple sites venous thrombosis: a case report.
abstract: BACKGROUND
  Tuberculosis is endemic in India and almost 40 % of the Indian population is infected with tubercle bacilli. Tuberculosis being a great mimicker of infectious as well as non infectious diseases and recent rise of multi drug resistant and extended drug resistant cases have made diagnosis and management more difficult. To the best of our knowledge there have been no reported cases of tuberculosis coexisting with malignant peritoneal mesothelioma leading to multiple site venous thrombosis.
  
  
  METHODS
  Forty five year old male, belonging to Indian/Aryan ethnicity presented with cough, breathlessness and fever for 7 months with past history of pulmonary tuberculosis. On examination he was found to have pleural effusion for which he received anti-tuberculosis therapy empirically. Later his condition deteriorated and on further examination he was found to have ascites, multiple site venous thrombosis and pyothorax which was found positive for acid fast bacilli. Despite anti-tuberculosis therapy he did not improve and was suspected to be a multidrug resistant case. Later on computed tomography peritoneal nodule was detected and on biopsy revealed malignant mesothelioma.
  
  
  CONCLUSIONS
  In a diagnosed case of tuberculosis with clinical findings compatible with it but not responding to anti tubercular therapy, underlying secondary co-existing pathology should be explored.
authors.affiliation: Department of Family Medicine, Sir Gangaram Hospital, New Delhi, 110060, India. pratyush410@yahoo.co.in.
authors.forename: Pratyush
authors.identifier: http://orcid.org/0000-0003-2915-0187
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Medicine, Sir Gangaram Hospital, New Delhi, India.
authors.forename: Kunal
authors.initials: K
authors.lastname: Chawla
authors.affiliation: Department of Medicine, Sir Gangaram Hospital, New Delhi, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khosla
authors.affiliation: Department of Medicine, Sir Gangaram Hospital, New Delhi, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Jain
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008654:Mesothelioma / Q000150:complications* / Q000000981:diagnostic imaging; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010690:Phlebography; D013902:Radiography, Thoracic; D013923:Thromboembolism / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000150:complications* / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging
keywords: Case report; Chylothorax; Malignant mesothelioma; Tuberculosis; Venous thrombosis