Tuberculous peritonitis in 11 children: Clinical features and diagnostic approach

Background: Tuberculous peritonitis (TBP) is a rare manifestation of childh ood tuberculosis characterized by long-lasting abdominal symptoms and exuda te and lymphocytes in the ascitic fluid. The diagnosis of TBP is rarely est ablished unless a high index of suspicion is maintained. Methods: The diagnostic features of 11 cases who were hospitalized with TBP in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Tu rkey, were evaluated retrospectively. Results: Seven cases were male and the ages of all cases ranged between 1 a nd 11 years. The onset of symptoms was 1-12 months (mean +/- SD 3.1 +/- 2.7 months) prior to the admission time. Nine patients gave a history of famil ial tuberculosis. Three cases had Bacillus Calmetee-Guerin (BCG) scars and the results of five tuberculin unit (TU) tests in cases without and with BC G were over 10 and 15 mm, respectively. The most common presenting clinical symptoms and signs at admission were abdominal distention and ascites (100 %), fever (27%) and loss of weight (18%). One case had accompanying tubercu lous meningitis and two cases had concomitant pulmonary tuberculosis. Only one of 11 samples of ascitic fluid yielded Mycobacterium tuberculosis by th e polymerase chain reaction method and no other microbiologic evidence was obtained in culture specimens. Ultrasonographic and computed tomographic im agings revealed high-density ascites that contributed well to the diagnosis . The diagnosis in two patients was proven histopathologically via peritone oscopy and laparoscopy. All cases were treated with isoniazide, rifampisin for 9 months and pyrazinamide for the first 2 months. Conclusions: Radiologic diagnostic techniques, positive skin tests and a hi story of exposure to tuberculosis may contribute to the diagnosis of TBP, h elped by clinical symptoms and findings, particularly when invasive diagnos tic methods via peritoneoscopy and laparoscopy are not available in develop ing countries.