Ascitic Type of Abdominal Tuberculosis in a 40 Year Old
Female
Muringani BN*
Department of Medical Microbiology, National University of science and technology, Zimbabwe
Received: July 18, 2017; Published: August 01, 2017
Corresponding author: Muringani BN, Department of Medical Microbiology, Faculty of Health Sciences, National University of science and technology,
Zimbabwe
Disseminated tuberculosis can cause a lot of damage to an individual if there is no early diagnosis. In Africa, about 70% of patients with
abdominal tuberculosis present with ascites and most of these cases are missed diagnostic cases. The case in question is of a 40 year old women
from one of the rural areas of Zimbabwe who had previously presented with severe coughing but had denied sweating at night and the sputum
results were negative on screening. After 2 weeks she presented again at the clinic with a swollen abdomen and the X-ray showed flooding of
the lungs and difficulty in breathing.
Disseminated tuberculosis can cause a lot of damage to an
individual if there is no early diagnosis. In Africa, about 70% of
patients with abdominal tuberculosis present with ascites and
most of these cases are missed diagnostic cases [1,2]. The patient
presents with a swollen abdomen containing many litres of strawcoloured
fluid. The fluid accumulates as the result of large numbers
of miliary tubercles on the peritoneum. The only certain way to
make the diagnosis is to do a minilaparotomy (‘’minilap’), which
will also enable you to diagnose cirrhosis, peri portal fibrosis (due
to Schistosomiasis mansoni), carcinomatosis of the peritoneum and
hepatoma (usually with cirrhosis). Experts can usually diagnose
miliary tuberculosis with their naked eyes; but even they can be
wrong, so take a biopsy of his parietal peritoneum and/or his liver.
[3] The case in question is 40year old women from one of the rural
areas of Zimbabwe who had previously presented with severe
coughing but had denied sweating at night and the sputum results
were negative on screening.
40 year old female presented to the clinic with abdominal
discomfort, shortness of breath due to the increased pressure on
your diaphragm from all the fluid build-up. The X-ray showed pleural
effusion and cosmetically disfigured large belly. Mental confusion
was significantly present as much as relatives said it was her normal
way of behaviour. The laboratory test of the ascites indicated a very
high albumin levels and Ziel Nielsen stain was positive for acid fast
bacteria characteristic of tuberculosis. HB was significantly low at
9.0 and peripheral smear showed polymophonucear cells at 60%
Ascite build up was concluded to be due to disseminated
tuberculosis which had initially caused pleural effusion in the
lungs, the TB had not been treated and thus the patient’s condition
worsened [3]. The patient was also immune suppressed and
her status had been overlooked as she had complained mainly
of her heart when she visited the clinic as she had difficulty in
breathing. The serum Albumin-Ascites Gradient (SAAG) WAS 6.1
Serum Albumin (40.0g/l) and ascites Albumin (33.3g/l). Urea and
creatinine were 14.5 and 289.9 respectively total bilirubin and
direct bilirubin were 26.4μmoland 13.7μmol respectively. The
results indicated a total liver failure and cirrhosis was now stage
4 with heavy swollen legs loss of appetite and disorientated. The
underlying problem was Disseminated Tuberculosis.
ISSN: 2574 -1241
