Karın ağrısı ve diyare ile başvuran peritoneal tüberküloz olgusunda asit sıvısı adenozin deaminaz aktivitesinin tanısal rolü

Year 2021, , 648 - 651, 18.10.2021

Haluk Mergen , Elif Erdem Harun Akar

https://doi.org/10.18521/ktd.932001

Abstract

Assiti bulunan periton tüberkülozu tanısı alan genç bir vaka burada sunulacaktır. Tüberküloz peritonit gelişimi için önemli risk oluşturabilecek durumlar arasında; kötü hijyen, aşırı nüfus, pastörize edilmemiş süt tüketimi, siroz, periton diyalizi, HIV enfeksiyonu, uyuşturucu kullanımı ve sağlık hizmetlerine yetersiz erişim bulunmaktadır. Genelde tüberküloz ajanı, gastrointestinal sisteme hematojen yolla, enfekte balgam yutulmasıyla veya doğrudan yayılma yoluyla ulaşır. Karın ağrısı, ishal, kilo kaybı, iştahsızlık, gece terlemeleri, asit sıvısı varlığı, bilateral plevral efüzyon, plevral nodül görünümü ve olgumuzda olduğu gibi peritonit karsinomatozunu düşündüren bulguları olan hastalarda ayırıcı tanıda peritoneal TB akla gelmelidir. Periton tüberkülozu, yüksek bir şüphe indeksi olmaksızın nadiren teşhis edilir.

Keywords

Tüberküloz, Assit, Adenozin Deaminaz

Supporting Institution

yok

The diagnostic role of ascitic fluid adenosine deaminase activity in a peritoneal tuberculosis case presenting with abdominal pain and diarrhea

Abstract

A young case diagnosed with peritoneal tuberculosis with ascites will be presented here. Conditions that may pose a significant risk for the development of tuberculous peritonitis; poor hygiene, overpopulation, consumption of unpasteurized milk, cirrhosis, peritoneal dialysis, HIV infection, drug abuse and inadequate access to healthcare. In general, the tuberculosis agent reaches the gastrointestinal system via hematogenous route, ingestion of infected sputum, or direct spread. Peritoneal TB should be considered in the differential diagnosis in patients with abdominal pain, diarrhea, weight loss, anorexia, night sweats, presence of ascitic fluid, bilateral pleural effusion, pleural nodule appearance, and findings suggestive of peritonitis carcinomatosis, as in our case. Peritoneal tuberculosis is rarely diagnosed, without a high index of suspicion for this disease.

Keywords

Tuberculose, ascites, adenosine deaminase

References

• 1. World Health Organization (2017) Global Tuberculosis Report 2017. World Health Organization Available: http://www.who.int/tüberküloz/publications/global_report/gtüberkülozr2017_annex1.pdf?ua=1
• 2. Marshall JB. Tuberculosis of gastrointestinal tract and peritoneum. Am J Gastroenterol 1993;88:989-99.
• 3. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis-presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005;22: 685-700.
• 4. Shakil AO, Korula J, Kanel GC, et al. Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease. A case control study. Am J Med 1996;100:179-85.
• 5. Manohar A, Simjee AE, Haffejee AA, et al. Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five years period. Gut 1990;31:1130-2.
• 6. Akpolat T. Tuberculous peritonitis. Perit Dial Int 2009;29:s166-9.
• 7. Khatri GR, Frieden TR. Controlling tuberculosisin in India. N Engl J Med 2002;347:1420-5.
• 8. Riquelme A, Calvo M, Salech F, et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol 2006; 40:705–710.
• 9. Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: Experience from 11 cases and review of the literature. World J Gastroenterol 2004;10:3647-9.
• 10. Vardareli E, Kebapci M, Saricam T, Pasaoglu O, Acikalin M. Tuberculous peritonitis of the wet ascitic type: Clinical features and diagnostic value of image-guided peritoneal biopsy. Dig Liver Dis 2004;36:199-204.
• 11. Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004;120:305-15.
• 12. Horvath KD, Whelan RL. Intestinal tuberculosis:return of an old disease. Am J Gastroenterol 1998;93:692-6.
• 13. Bolognesi M, Bolognesi D. Complicated and delayed diagnosis of tuberculous peritonitis, Am J Case Rep 2013;16;14:109-12. http://dx.doi.org/10.12659/ajcr.883886
• 14. Taskıran E, Yıldırım M, Soyaltın UE, Gulle S, Dereli MS, Akar H. Tuberculosis infection with hepatic involvement mimicking liver metastasis in an elderly patient. European Geriatric Medicine 2016;7:369-71.
• 15. Sevgili B, Kaypak MA, Somay R, Atalay S, Köse Ş, Akar H. Extrapulmonary tuberculosis mimicking gynecological malignancies. FNG & Demiroğlu Bilim Tıp Dergisi 2019;5(1):32-35.