Peritoneal tuberculosis in a 15-month-old male: Surgical diagnosis of an insidious disease

Background: Peritoneal involvement is a relatively rare complication of tuberculosis, accounting for approximately 3.3% of extrapulmonary disease in the United States. Clinical diagnosis relies on a preponderance of indirect evidence and is often delayed. We describe such a patient. Methods: An otherwise healthy 15-month-old male presented with fever, abdominal distention, vague abdominal pains, and a few episodes of watery diarrhea. Standard laboratory and radiologic work-up was unrevealing, and after a prolonged hospitalization, caseating granulomas were identified at diagnostic laparotomy. Results: Definitive treatment was further delayed pending culture results, and the patient's condition worsened until fulminant cardiovascular collapse led to his demise. Conclusions: Despite effective chemotherapeutic regimens, the overall mortality of tuberculous peritonitis may be as high as 51%. The diagnosis must be considered and empiric anti-tuberculous treatment started early in the course of the disease, even if definitive diagnosis is still pending.