Peritoneal Tuberculosis Presenting as Chronic Ascites With Scrofula: A Case Report

  • Galina Bogoslovskaya Department of Internal Medicine, Pietersburg Provincial Hospital, Limpopo University, Polokwane, South Africa
  • Jose Zaldivar Department of Internal Medicine, Pietersburg Provincial Hospital, Limpopo University, Polokwane, South Africaa
Keywords: Chronic Ascitis, Extrapulmonary Tuberculosis, Ovarian Neoplasms, Peritonitis, Tuberculous, Tuberculosis, Lymph Node


Peritoneal tuberculosis (PTB) is a common type of extrapulmonary tuberculosis; however, due to variety of clinical presentations, diagnostic challenges do occur. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. In addition, PTB can mimic a malignancy, especially in women who present with ascites and elevated cancer antigen (CA) 125 levels. A high index of suspicion is an important factor in an early diagnosis. Moreover, an early diagnosis and the initiation of antituberculous therapy are essential for preventing morbidity and mortality. Fortunately, most of these patients respond very well to standard antituberculous therapy.

Here, we have reported the case of a young female patient who presented with chronic ascites, mild abdominal tenderness, and later, scrofula. Ultimately, she was diagnosed with PTB based on her test results. We expect that this case report will contribute to the existing literature on this subject.


Peto HM, Pratt RH, Harrington TA, et al. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis 2009; 49: 1350-7;

Churchyard GJ, Mametja LD, Mvusi, et al. Tuberculosis control in South Africa: successes, challenges and recommendations. South Africa Med J 2014; 104 (3 Suppl 1): 244-8;

Padayatchi N, Daftary A, Naidu N, et al. Tuberculosis: treatment failure, or failure to treat? Lessons from India and South Africa. BMJ Glob Health 2019; 4: e001097;

Oge T, Ozalp S, Yalcin OT, et al. Peritoneal tuberculosis mimicking ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2012; 162: 105-8;

Department Health, Republic of South Africa. National Tuberculosis Management Guidelines 2014. Available at (last accessed June 2019)

Sood R, Sethu Madhavan M. Diagnostic approach to abdominal tuberculosis. In: Agarwal AK, Jain DG, editors. Clinical Medicine: A Practical manual for students and practitioners. Delhi (India): Jaypee Brothers Medical Publishers (P) Ltd, 2007; p. 249

Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis-presenting features, diagnostic strategies and treatment, Alimentary Pharmacology and Therapeutics. Aliment Pharmacol Ther 2005; 22: 685-700;

Sharma V, Singh H, Mandavdhare HS. Tubercular Abdominal Cocoon: Systematic Review of an Uncommon Form of Tuberculosis. Surg Infect (Larchmit) 2017; 18: 736-41;

Bonura C, Carlo PD, Spicola D, et al. Rapidly growing mycobacteria in TB/HIV co-infection: a report of two cases focusing on difficulties in diagnosis and management. New Microbiol 2012; 35: 239-43

Shu CC, Wu VC, Yang FJ, et al. Predictors and prevalence of latent tuberculosis infection in patients receiving long-term hemodialysis and peritoneal dialysis. PLoS One 2012; 7: e42592;

Huang LL, Xia HH, Zhu S. Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. Clin Transl Hepatology 2014; 2: 58-64;

Ramirez-Lapausa M, Menendez-Saldana A, Noguerado-Asensio A. Extrapulmonary tuberculosis: an overview. Rev Esp Sanid Penit 2015; 17: 3-11;

Daaloul W, Gharbi H, Ouerdiane N, et al. Disseminated peritoneal tuberculosis simulating ovarian cancer. Tunisia Med 2012; 90: 333-5

Kubota M, Suzuki J, Morisawa Y. Tuberculosis Peritonitis Mimicking Ovarian Cancer Metastasis. Intern Med 2019; 58: 763-4;

Tao L, Ning HJ, Nie HM, et al. Diagnostic value of adenosine deaminase in ascites for tuberculosis ascites: a meta-analysis. Diagn Microbiol Infect Dis 2014; 79: 102-7;

Sharma SK, Ryan H, Khaparde S, et al. Index-TB Guidelines: Guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 2017; 145: 448-63

Barua R, Hossain MA. Adenosine Deaminase in Diagnosis of Tuberculosis: A Review. Anwer Khan Modern Medical College Journal 2014; 5: 43-8

Bera C, Michael JS, Burad D, et al. Tissue Xpert™ MTB/Rif assay is of limited use in diagnosing peritoneal tuberculosis in patients with exudative ascites. Indian J Gastroenterol 2015; 34: 395-8;

Daley BJ. How is tuberculosis peritonitis (TP) diagnosed? Updated: Jan 11, 2017. Medscape. Available at (last accessed June 2019)

Sharma V, Mandavdhare HS, Lamoria S, et al. Serial C-reactive protein measurements in patients treated for suspected abdominal tuberculosis. Dig Liver Dis 2018; 50: 559-62;

Vardareli E, Kebapci M, Saricam T, et al. Tuberculous peritonitis of the wet ascitic type: clinical features and diagnostic value of image-guided peritoneal biopsy. M Dig Liver Dis 2004; 36: 199-204;

Soni H, Bellam BL, Rao RK, et al. Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis. Infection 2019; 47: 387-94;

Tierney D, Nardell EA. Extrapulmonary Tuberculosis (TB). MSD Manual Professional version 2019. Last full review/revision April 2018. Available at (last accessed June 2019)

Case report
Abstract: 241 views
HTML: 38 views
PDF: 86 views