Type 2 Diabetes Complicated by Tuberculous Peritonitis. Case Report.

Abstract

A 64-year-old woman with poorly controlled type 2 diabetes who had been treated with insulin for 24 years was admitted to our hospital complaining of fever and abdominal fullness. An abdominal CT scan showed massive ascites. The cell count of the ascitic fluid was elevated, and most of the cells were lymphocytes. There were also marked elevations of ADA, CA 125, IL-2R, and hyaluronic acid in the ascitic fluid, but Mycobacterium tuberculosis was not detected. Laparoscopic examination revealed bowel adhesions and multiple nodules in the peritoneum and liver, and the peritoneal cavity was occupied by multiple spidery fibrous masses. Granulomas composed of Langhans giant cells were detected in a peritoneal biopsy specimen. We made a diagnosis of tuberculous peritonitis and started antitubercular therapy. The patient had a good clinical course, and her ascites gradually decreased and resolved by 30 days after the start of treatment. We report a rare case of type 2 diabetes complicated by tuberculous peritonitis, which accounts for only 0.3% of all cases of tuberculosis.