Abstract
A case of tuberculous pleuro-peritonitis with massive bilateral pleural effusions is reported. A 20-year-old woman was admitted to our hospital for evaluation and treatment of a fever which had persisted for more than 2 weeks. On admission, she had a remittent fever, with peak as high as 41°C, and increased serum levels of CRP, transaminases, LDH and alkaline phosphatase. Despite intravenous administration of antibiotics, her fever persisted, and left pleural effusion was found by chest X-ray film on the 8th day after admission. The pleural effusion was an exudate, and cytological and bacterial examinations were negative. Ascites was found by abdominal CT scan, and a drainage tube was inserted into the left pleural space because of increased pleural effusion on the 13th hospital day. Then, right massive pleural effusion was noted on the 16th hospital day, and a second drainage tube was inserted into the right pleural space. The diagnosis of tuberculous pleuritis was made by pathological examination of a pleural biopsy specimen which showed an epitheloid granuloma with typical Langhans type giant cells and acid-fast bacilli. Antituberculous therapy was started, and all clinical symptoms and signs improved with this therapy. Cases of tuberculous pleuroperitonitis have been rare. Only 15 cases have been reported in Japan since 1980.
