Korean J Gastroenterol.  2011 Jun;57(6):379-383. 10.4166/kjg.2011.57.6.379.

A Case of Tuberculous Peritonitis Developed during Chemotherapy for Tuberculous Pleurisy as Paradoxical Response

• Kim SY
• Oh TH
• Seo JY
• Hong JH
• Jeon TJ
• Seo DD
• Shin WC
• Choi WC

• KMID: 1792804
• DOI: http://doi.org/10.4166/kjg.2011.57.6.379

Abstract

After the start of anti-tuberculous treatment, paradoxical worsening of tuberculous lesions has been described. However, abdominal tuberculosis as paradoxical response is relatively rare. This report describes the 26-year-old female who suffered from peritoneal tuberculosis while treating tuberculous pleurisy with anti-tuberculous medications. It was considered as paradoxical response, rather than treatment failure or else. She was successfully managed with continuing initial anti-tuberculous medications. When a patient on anti-tuberculous medications is presented with abdominal symptoms, the possibility of paradoxical response should be considered to avoid unnecessary tests and treatments, which may result in more suffering of the patient. Herein, we report a case of peritoneal tuberculosis as paradoxical response while treating tuberculous pleurisy.

Keyword

Paradoxical response; Tuberculous peritonitis; Tuberculous pleurisy; Peritoneal tuberculosis

Figure

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  Fig. 1. Chest X-ray. (A) The initial chest X-ray showed left sided pleural effusion. (B) On admission, 10 weeks later, left sided pleural effusion was decreased. (C) Left sided pleural effusion was almost resolved 9 months after the start of antituberculous treatment.

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  Fig. 2. Abdominal CT. Ascites and smooth uniform thickening with pronounced enhancement (arrows) and smudged pattern of the peritoneum (arrow heads), known as radiologically characteristic findings of tuberculous peritonitis, were shown (A, B). Ascites and the extent of smudged pattern of peritoneum disappeared 6 months after the start of antituberculous treatment (C, D).

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  Fig. 3. Gross findings through the laparoscope. Diffuse whitish nodules with ascites were noted on the peritoneum and the intestines (A, B).

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  Fig. 4. Microscopic findings of peritoneum. Multinucleated giant cell (arrows) and chronic granulomas with epithelioid cells, consistent with tuberculous peritonitis, were noted (H&E, ×100).

Reference

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