Korean J Gastroenterol.  2011 Aug;58(2):111-116. 10.4166/kjg.2011.58.2.111.

A Case of Chlamydia trachomatis Peritonitis Mimicking Tuberculous Peritonitis

• Kang HM
• Oh TH
• Kang GH
• Joen TJ
• Seo DD
• Shin WC
• Choi WC
• Yang KH

• KMID: 1718420
• DOI: http://doi.org/10.4166/kjg.2011.58.2.111

Abstract

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.

Keyword

Peritonitis; Chlamydia trachomatis

MeSH Terms

Adult
Anti-Bacterial Agents/therapeutic use
Ascites/diagnosis/metabolism/therapy
Ascitic Fluid/chemistry
Cephalosporins/therapeutic use
Chlamydia Infections/complications/*diagnosis/drug therapy
Chlamydia trachomatis/genetics/*isolation & purification
Diagnosis, Differential
Female
Humans
Laparoscopy
Peritonitis/*diagnosis/etiology/radiography
Peritonitis, Tuberculous/diagnosis
Serum Albumin/metabolism
Tomography, X-Ray Computed

Figure

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  Fig. 1. Simple abdominal x-ray. The picture showed small bowel ileus and hazziness suggesting ascites in the whole abdomen.

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  Fig. 2. Enhanced abdominopelvic CT scan. (A) The picture showed abrupt luminal narrowing (arrow) of the mid-ileum with proximal small bowel dilatation. (B) Ascites (arrow) was noted. (C) Omental nodular infiltration and peritoneal thickening (arrow heads) suggesting peritonitis was seen. (D) Swelling of both ovaries (arrows) was seen in the pelvis.

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  Fig. 3. Laparoscopic finding and microscopic findings. (A) Laparoscopic examination showed slight swelling of both ovaries (arrow) without omental nodular infiltration and peritoneal thickening on the pelvis. (B) Ovarian (H&E, ×100) and (C) fimbrial tissue (H&E, ×40) with diffuse infiltrative plasma cells consisting with salpingo-oophoritis were noted on the laparoscopic biopsies.

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  Fig. 4. Follow-up contrast enhanced abominopelvic CT scan. The picture showed improved state of peritonitis and small bowel ileus.

Reference

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