Caso Clínico: Tuberculosis Peritoneal
Palabras clave:
TUBERCULOSIS PERITONEAL, TUBERCULOSIS, ASCITIS, GRANULOMA, TUBERCULOUS PERITONITIS, ASCITESResumen
INTRODUCCIÓN: La tuberculosis peritoneal es una entidad poco frecuente, caracterizada por la siembra directa de bacilos tuberculosos procedentes de órganos intraabdominales, ganglios linfáticos rotos o bien por vía hematógena. Al ser poco común, el reporte del caso permitirá incluir a la tuberculosis peritoneal dentro del diagnóstico diferencial en pacientes que presenten dolor abdominal inespecífico, fiebre y sobretodo, ascitis.
CASO CLÍNICO: Se trata de un paciente masculino de 40 años que acudió por presentar sensación de alza térmica no cuantificada, pérdida de peso progresiva y distensión abdominal de 3 meses de evolución. Al examen físico se encontró fiebre de 38.5°C y signos de ascitis.
EVOLUCIÓN: A partir del análisis del líquido peritoneal, se descartaron todas las causas que producen índice de GASA menor a 1.1 g/dL (gradiente albúmina suero/líquido ascítico), entre éstas principalmente infecciones intraperitoneales y carcinomatosis; siendo necesaria la realización
de una laparotomía diagnóstica con toma de biopsia de las siembras a nivel de peritoneo, epiplón y mesenterio. El resultado de anatomía patológica reportó granulomas no caseosos, y el cultivo de Lowenstein Jensen luego de dos meses fue positivo para tuberculosis. El paciente presentó una evolución favorable con el tratamiento específico instaurado, evidenciándose mejoría clínica y en los exámenes complementarios.
CONCLUSIÓN: Se presenta un caso atípico en el que la sospecha clínica y el análisis meticuloso permitieron llegar a un diagnóstico certero. La falta de necrosis caseosa en los granulomas (signo característico de la tuberculosis) no debería descartar la enfermedad, especialmente si existen signos sugestivos de tuberculosis.
ABSTRACT
Case Report: Tuberculous Peritonitis.
BACKGROUND: Tuberculous Peritonitis is an uncommon entity characterized by a direct sowing of Koch’s bacillus coming from intra-abdominal organs, ruptured lymph nodes or through bloodstream. This case report concerns about a very rare illness and will allow inclusion of tuberculous peritonitis within the differential diagnosis in patients who have nonspecific abdominal pain, fever and ascites.
METHODS: This is a descriptive study in which two educational institutions in the city of Cuenca - Ecuador were included. Two questionnaires were applied: the first one on bullying and mistreatment of students and the other questionnaire about teacher’s perception of school climate; both of them were validated previously. Basic statistics were used for description of the information from the study.
CLINICAL CASE: A 40-year old male who attended because of a no quantified thermal raise feeling, progressive weight loss, abdominal distension and pain that began about 3 months earlier. Physical examination revealed a 38.5 °C fever, and signs of ascites.
EVOLUTION: From the analysis of the peritoneal fluid, the causes that produce a GASA index value under 1.1 g/dL (serum albumin gradient/ascitic fluid) were discarded, among them we can mention mainly intra-peritoneal infections and carcinomatosis; performance of a diagnostic laparotomy was required to biopsy the tuberculous sowing from the peritoneum, omentum and mesentery. The result of pathology test reported not caseous granulomas, and after two months the Lowenstein-Jensen’s cultivation of the samples was positive for tuberculosis. The patient evolution was positive after establishing specific tuberculosis treatment, clinical and complementary examinations healing findings were successful.
CONCLUSION: This is an uncommon case in which clinical suspicion and careful analysis led to an accurate diagnosis. The lack of caseous necrosis in granulomas (hallmark of tuberculosis) should not discard the disease, especially if there are suggestive signs of tuberculosis.
