ABDOMINAL TUBERCULOSIS - A DIAGNOSIS NOT TO MISS

A 61 year old Asian male presented with complaints of one month history of epigastric discomfort and microcytic anemia on recent blood test. Detailed history was suggestive that the pain was intermittent, was associated with generalized abdominal discomfort with loss of appetite for around two months. No history of hematemesis, malena or dysphagia. He had a past history of stroke in 2004 and since then had left sided hemiplegia and constipation. Use of laxative helped him to good effect. ON EXAMINATION- Abdomen was soft, non tender, no organomegaly Examination of all other systems was unremarkable INVESTIGATIONS- He underwent a series of investigations for his abdominal complaints which included Oesophago-gastro-duodenoscopy, colonoscopy, malignancy markers and serum electrophoresis – all were found to be negative. CT scan abdomen and pelvis done subsequently was suggestive of significant ascites with wall thickening in jejunum so a possibility of small bowel carcinoma was raised with multiple metastatic lesions in spleen. DIAGNOSIS- Later when this case was discussed in MDT, it was suggested that he should undergo a diagnostic laparoscopy and a gold quantiferon test for probable TB infection. Culture of peritoneal fluid was unremarkable and cytology report was suggestive of lymphocytosis While the histology report of peritoneal biopsy and omentum ruled out evidence of malignancy, there was focal non casseating granulomatous inflammation for which the diagnosis of Abdominal Tuberculosis was made. MANAGEMENT - He was started on anti-tuberculous drugs and later on follow up showed good recovery and improvement.