Abdominal distension and low grade fever in a refugee from SudanBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1252 (Published 10 September 2008) Cite this as: BMJ 2008;337:a1252
- Rachel J Ali, specialist registrar in gastroenterology1,
- Harry R Dalton, consultant gastroenterologist and honorary senior lecturer12
- 1Cornwall Gastrointestinal Unit, Royal Cornwall Hospital, Truro
- 2Peninsula College of Medicine and Dentistry, Royal Cornwall Hospital, Truro
A 34 year old Sudanese refugee presented with a four month history of malaise and generalised abdominal swelling. On examination, he had a temperature of 37.9°C and moderate ascites.
Initial investigations are as follows.
Alkaline phosphatase 171 U/l (3-110 U/l)
Alanine transaminase 54 U/l (3-35 U/l)
Bilirubin 18 μmol/L (3-17 μmol/l)
Albumin 36 g/l (35-45 g/l)
International normalised ratio 1.0
Normal chest radiograph
Abdominal ultrasonography showed moderate ascites, normal looking liver, portal, and hepatic veins
Abdominal triphasic computed tomography confirmed ultrasonography findings, no other abnormality was seen
Bloodstained peritoneal aspirate
White cell count 1250/µl (80% lymphocytes)
Albumin 27 g/l
Cytology negative (×2 samples)
Gram and acid fast bacilli stain negative (×2 samples)
1. What is the diagnosis?
2. What investigation would best confirm this diagnosis?
3. What is the treatment?
1. In view of this patient’s background, low serum-ascites albumin gradient, low grade fever, negative cytology, and unhelpful cross sectional radiology the most likely diagnosis is tuberculous peritonitis. A normal chest radiograph does not exclude this diagnosis.
2. The diagnosis should be confirmed by laparoscopy and biopsy of omental tuberculous deposits in the peritoneal cavity.
3. Anti-tuberculous chemotherapy for six …