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CASE REPORT
Abdominal tuberculosis with a Pseudo-Sister Mary Joseph nodule mimicking peritoneal carcinomatosis
  1. Amine Awad1,2,
  2. Tom Pampiglione1 and
  3. Zaker Ullah1
  1. 1 Whipps Cross University Hospital, Barts Health NHS Trust, London, London, UK
  2. 2 Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
  1. Correspondence to Dr Amine Awad, amine.awad{at}ouh.nhs.uk

Abstract

A 46-year-old woman presented in severe abdominal pain on a background of 3 months of weight loss and intermittent vomiting. She had visited East Africa 6 months prior but reported no unwell contacts. On examination, she had generalised abdominal tenderness, distension and a painful paraumbilical swelling. CT scanning confirmed small bowel obstruction and revealed widespread peritoneal nodules, lymphadenopathy, ascites and a soft tissue paraumbilical mass. CA-125 tumour marker was elevated. However, transvaginal ultrasound scanning showed normal-appearing ovaries. She underwent a diagnostic laparoscopy for ascitic fluid analysis and biopsy of omental and peritoneal nodules, which revealed a lymphocytic exudate and caseating granulomas, respectively. Interferon-γ release assay and repeated stains for acid-fast bacilli were negative. She was commenced on antituberculous chemotherapy for a presumed diagnosis of abdominal tuberculosis. Positive culture results 2 weeks later confirmed Mycobacterium tuberculosis infection. The patient experienced a complete resolution of symptoms within 6 weeks of treatment.

  • TB and other respiratory infections
  • hepatitis and other GI infections
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Footnotes

  • Contributors AA, TP and ZU identified the case. AA reviewed the case notes and wrote the manuscript. TP and ZU managed the case and critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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