Mauricio Jones, DO1, Juan Negron-Diaz, MD1, Ryan Beaver, DO1, Alexia Stewart, MSN2 1Baylor Scott & White, Temple, TX; 2Baylor Scott & White Medical Center, Temple, TX
Introduction: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria that is well-known for its pulmonary involvement. However, TB can affect almost every part of the human body. We describe a case of abdominal tuberculosis in a previously healthy 44-year-old male presenting with abdominal distension for one month, who was found to have an ileocecal mass and ascites initially concerning for malignancy. This case will highlight the clinical presentation and challenges to diagnose abdominal TB.
Case Description/Methods: The patient is a 44-year-old male with no significant past medical history presented as a transfer from an outside facility with a chief complaint of productive cough, decreased appetite, early satiety, and abdominal fullness for one month. The patient was admitted for CT findings with a concern for peritoneal carcinomatosis and omental caking. The patient, primarily Spanish-speaking, was originally from Mexico and relocated to Central Texas 10 years ago. He denies any chronic medical problems or the use of any medications. He does have a significant remote alcohol history to which he admits to drinking 8-10 beers daily. No history of active or latent TB including prior testing. He denied any IV drug use, HIV infection, prior STDs, or ever having been in jail or prison.
Discussion: There are numerous risk factors for peritoneal TB. Liver pathology leading to ascites including cirrhosis is a well-known cause. Immunosuppression is another risk factor. There is also a disposition in the Hispanic and Asian populations. According to the CDC, in 2020 TB disease was reported in 2,133 Hispanic or Latino persons in the United States, accounting for nearly 30% of all people reported with TB nationally. This accounts for the second largest ethnicity behind Asians with 36%. A diagnosis of an alcohol use disorder results in an increased risk of tuberculosis by nearly 11%. The relationship between alcohol consumption and tuberculosis can be explained by two causal pathways. First, alcohol consumption impairs the immune system, which increases susceptibility to tuberculosis infection, as well as reactivation of latent tuberculosis. Apart from direct influences on the immune system, alcohol consumption is associated with malnutrition, liver disease, and social drift, all of which impact the maintenance of innate and acquired immune systems. Alcohol consumption may also lead to its presence in social environments which can also facilitate the spread of tuberculosis infection.
Figure: Image A - There is complete opacification of the right hemithorax with a mild contralateral right to left mediastinal shift. Left basilar subsegmental atelectasis/scar.
Image B - CT Scan of the abdomen with omental thickening
Disclosures:
Mauricio Jones indicated no relevant financial relationships.
Juan Negron-Diaz indicated no relevant financial relationships.
Ryan Beaver indicated no relevant financial relationships.
Alexia Stewart indicated no relevant financial relationships.
Mauricio Jones, DO1, Juan Negron-Diaz, MD1, Ryan Beaver, DO1, Alexia Stewart, MSN2. P1692 - Extrapulmonary Tuberculosis Affecting the Peritoneum, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
