Peritoneal Tuberculosis: An Underestimated Diagnosis

Tuberculosis is an infectious disease that most often affects the lungs, it is of human-to-human transmission caused by Mycobacterium tuberculosis, and is still a major public health problem worldwide. In Morocco, a total of 29,327 cases were notified and put on treatment in 2021, as part of the National Tuberculosis Control Program (PNLAT). We report a case of peritoneal tuberculosis in a young female patient aged 18, who had presented for 10 days with a progressive increase in abdominal volume associated with vomiting and diarrhea. Due to the exudative and lymphocytic nature of the ascites fluid, a molecular biology PCR GeneXpert® MTB/RIF test for Mycobacterium tuberculosis complex was carried out and found to be positive, leading to the diagnosis of peritoneal tuberculosis. The diagnosis of peritoneal tuberculosis is not always easy, as the clinical signs are often insidious and unspecific. The most common are weight loss, fever and abdominal pain. Diagnosis must be based on clinical and radiological evidence, but confirmation must be bacteriological and/or histological. Bacterial culture remains the gold standard. Technological progress, particularly in molecular biology, has provided clinicians with new tools of diagnosing tuberculosis. The GeneXpert® test, approved for use by the WHO in December 2010. GeneXpert® has also made it possible to detect resistance to Rifampicin. In an endemic area, any unusual presentation of abdominal enlargement should raise suspicion of peritoneal tuberculosis to ensure timely therapeutic intervention. The management of peritoneal tuberculosis is multidisciplinary and requires coordination between physicians, bacteriologists and surgeons.