癌性腹膜炎の疑いで審査腹腔鏡を行い、結核性腹膜炎と診断し得た1例

抄録

  Tuberculous peritonitis may cause ascites, peritoneal thickening, and elevation of CA125 levels. We report a case of tuberculous peritonitis diagnosed during exploratory laparoscopy. A 60-year-old woman complained of abdominal pain and distention, diarrhea, and fever for 2 months. Imaging studies, including positron emission tomography, showed peritoneal thickening with a fluorodeoxyglucose hotspot. Evaluation of ascites fluid, obtained via abdominocentesis, revealed an elevated lymphocyte count, elevated adenosine deaminase levels, and negative cytology. These findings were suggestive of tuberculous peritonitis; however, polymerase chain reaction and T-SPOT test results, which would have provided a definitive diagnosis, were negative. The patient was subsequently referred to our hospital and underwent exploratory laparoscopy. Her peritoneum was reddish and thickened, without evidence of disseminated cancer; both ovaries appeared normal. An ascites fluid sample was collected, and peritoneal biopsy was performed. A loop-mediated isothermal amplification assay (LAMP) of the ascites revealed the presence of Mycobacterium tuberculosis. Finally, we confirmed the diagnosis of tuberculous peritonitis. The pathological examination of the peritoneal biopsies also supported the diagnosis. Treatment with ethambutol, rifampicin, isoniazid, and pyrazinamide was initiated immediately. The patient recovered smoothly with the treatment, which was continued for 6 months. Tuberculous peritonitis was diagnosed during exploratory laparoscopy, allowing immediate initiation of the appropriate treatment. Tuberculous peritonitis is a rare disease, and its symptoms and clinical findings are often similar to those of malignancy. For accurate and immediate diagnosis, exploratory laparoscopy and LAMP examination can be candidates for the most effective diagnostic tools.