Disseminated tuberculosis can cause a lot of damage to an individual if there is no early diagnosis. In Africa, about 70% of patients with abdominal tuberculosis present with ascites and most of these cases are misdiagnosed cases. The case in question is of a 40year old women from one of the rural areas of Zimbabwe who had previously presented with severe coughing but had denied sweating at night and the sputum results were negative on screening. After 2months she presented again at the clinic with a swollen abdomen and the X-ray showed flooding of the lungs and difficulty in breathing.

Keywords: ascites, military, carcinomatosis, pleural effusion

Disseminated tuberculosis can cause a lot of damage to an individual if there is no early diagnosis. In Africa, about 70% of patients with abdominal tuberculosis present with ascites and most of these cases are misdiagnosed cases.^1,3

The patient presents with a swollen abdomen containing many litres of straw-coloured fluid. The fluid accumulates as the result of large numbers of military tubercles on the peritoneum. The only certain way to make the diagnosis is to do a minilaparotomy (''minilap'), which will also enable you to diagnose cirrhosis, periportal fibrosis (due to Schistosomiasis mansoni), carcinomatosis of the peritoneum and hepatoma (usually with cirrhosis). Experts can usually diagnose military tuberculosis with their naked eyes; but even they can be wrong, so a biopsy of the patient’s parietal peritoneum should be taken.²

The case in question is of a 40year old women from one of the rural areas of Zimbabwe who had previously presented with severe coughing but had denied sweating at night and the sputum results were negative on screening.

40 year old female presented to the clinic with

Abdominal discomfort, shortness of breath due to the increased pressure on her diaphragm from all the fluid build-up The X-ray showed pleural effusion and a cosmetically disfigured large belly. Mental confusion was significantly present as much as relatives said it was her normal way of behaviour.

The laboratory test of the ascites indicated very high albumin levels and Ziel Nielsen stain was positive for acid fast bacteria characteristic of tuberculosis. HB was significantly low at 9.0 and peripheral smear showed polymophonucear cells at 60%.

Ascite build up was concluded to be due to disseminated tuberculosis which had initially caused pleural effusion in the lungs, the TB had not been treated and thus the patient’s condition worsened.3 The patient was also immunosuppressed and her status had been overlooked as she had complained mainly of her heart when she visited the clinic as she had difficulty in breathing.

The serum Albumin-Ascites Gradient (SAAG) WAS 6.1Serum Albumin (40.0g/l) and ascites Albumin (33.3g/l). Urea and creatinine were 14.5 and 289.9respectively. While total bilirubin and direct bilirubin were 26.4µmol and 13.7µmol respectively.

Indicated a total liver failure and cirrhosis was now stage 4 with heavy swollen legs, loss of appetite and disorientation. Severe tissue necrotization was also present with a number of blisters all over the body. The underlying problem was Disseminated Tuberculosis.

None.

We declare that we have no competing interests.

1. Peng YC, Lin CL, Hsu WY, et al. Risk of liver cirrhosis in patients with tuberculosis: a nationwide cohort study. Eur J Clin Invest. 2018;45(7):663‒669.
2. Lin YT, Wu PH, Lin CY, et al. Cirrhosis as a risk factor for tuberculosis infection--a nationwide longitudinal study in Taiwan. Am J Epidemiol. 2014;180(1):103‒110.
3. Muringani BN. The Rise of Drug-Resistant Tuberculosis in Southern Africa: Are We Learning From History Or Repeating It? Journal of Allied Medical Science and Clinical Research. 2016;1:1‒6.