Some patients have ascites without having liver disease, so it is important to analyze the cause of these ascites. Tuberculous peritonitis is an infectious disease characterized by lymphocyte-dominant exudative ascites. In contrast, myxedema ascites is a very rare disease characterized by a high serum/ascites albumin gradient (SAAG) with hypothyroidism. We herein report a case involving a 48-year-old woman with both diseases simultaneously. She was hospitalized because of massive ascites, generalized edema, and a puffy face. Hypothyroidism was confirmed by thyroid function tests. Her ascitic fluid had a high SAAG; no other specific findings were identified by cytology, culture, or computed tomography. Three months after initiating drug therapy for the hypothyroidism, the patient's systemic edema improved but the ascites recurred. Accordingly, diagnostic laparoscopy was performed, and tuberculous peritonitis was confirmed. As seen in this case, when myxedema ascites is associated with tuberculous peritonitis, an accurate diagnosis may be challenging.
Ascites* ; Ascitic Fluid ; Communicable Diseases ; Diagnosis ; Drug Therapy ; Edema ; Female ; Humans ; Hypothyroidism ; Laparoscopy ; Liver Diseases ; Middle Aged ; Myxedema* ; Peritonitis, Tuberculous* ; Rare Diseases ; Thyroid Function Tests

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.
Adult ; Anti-Bacterial Agents/therapeutic use ; Ascites/diagnosis/metabolism/therapy ; Ascitic Fluid/chemistry ; Cephalosporins/therapeutic use ; Chlamydia Infections/complications/*diagnosis/drug therapy ; Chlamydia trachomatis/genetics/*isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Peritonitis/*diagnosis/etiology/radiography ; Peritonitis, Tuberculous/diagnosis ; Serum Albumin/metabolism ; Tomography, X-Ray Computed

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diasnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.
Antitubercular Agents/*adverse effects/*therapeutic use ; DNA, Bacterial/analysis ; Humans ; Laparoscopy ; Liver/pathology/ultrasonography ; Liver Abscess/*chemically induced/*diagnosis/microbiology ; Male ; Mycobacterium tuberculosis/genetics/isolation & purification ; Necrosis/pathology ; Peritoneum/pathology ; Peritonitis, Tuberculous/*drug therapy ; Tomography, X-Ray Computed ; Tuberculosis/*diagnosis/microbiology ; Young Adult