Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites

• Type of Material: Article
• Authors: Lauren Crossman, Emory University; Christopher Ronald Funk, Emory University; Sheetal Kandiah, Emory University; Reena Hemrajani, Emory University
• Language: English
• Date: 2023-01-01
• Publisher: Hindawi
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Lauren Crossman et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1155/2023/4240423
• Title of Journal or Parent Work: Case Reports in Nephrology
• Volume: 2023
• Start Page: 4240423
• End Page: 4240423
• Grant/Funding Information: Support for publication fees was provided by the Emory Division of Hospital Medicine Publishing Fund.
• Research Categories: Health Sciences, Epidemiology

Abstract

A middle-aged immigrant male from a region with endemic tuberculosis who had a history of end-stage kidney disease presented to the emergency room for routine hemodialysis and abdominal swelling. He was admitted to the medicine service for suggested daily dialysis to improve his volume overload, which was attributed to nephrogenic ascites. He was found to have several findings concerning for systemic illness, including fevers, night sweats, hypercalcemia, lymphadenopathy, omental thickening, ascitic fluid with a serum ascites albumin gradient of less than 1.1 gm/dL, and exudative pleural effusions. Our suspicion for hematologic malignancy versus disseminated infection was high. During admission, there were many diagnostic challenges in obtaining histologic and bacteriologic confirmation of our leading suspected diagnosis, disseminated tuberculosis. Ultimately, tuberculosis infection was confirmed with histologic evidence of granulomatous inflammation of cervical lymph node and sputum culture positive for Mycobacterium tuberculosis. This case highlights the necessity for every patient presenting with new ascites to undergo diagnostic paracentesis. Nephrogenic ascites is a rare syndrome that is possible in volume overloaded states but is a diagnosis of exclusion that should be supported by an exudative serum ascites albumin gradient and no evidence of an alternate etiology.