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Background: The simultaneous involvement of the pleura and peritoneum with tuberculosis in the absence of pulmonary foci is an uncommon condition that may lead physicians to misdiagnose. Case Presentation: Herein, we present a Persian male adult who manifested with epigastric pain, weakness, and a history of pleuritic chest pain two months prior to admission. The findings of the physical examination included vital signs within the normal range, unilateral fine crackle in the lung, abdominal distension with positive shifting dullness, and fluid wave test. Analysis of the ascitic fluid revealed a Serumascites albumin gradient (SAAG) of less than 1.1g/dl, indicating a non-portal condition. The results of the acid-fast bacilli (AFB) staining as well as the TB polymerase chain reaction (PCR) test were negative. However, the adenosine deaminase (ADA) level was 44 IU/L. A chest CT scan revealed mediastinal lymph node enlargement and pleural thickening with loculated pleural effusion. Three acid-fast bacilli smear of morning sputum were sent, and all three were negative. An abdominopelvic CT scan showed multiple periaortic and mesenteric lymph nodes of varying sizes with mesenteric haziness and accumulation of effusion in the peritoneal cavity. Eventually, peritoneal biopsy, the gold standard, was performed, which revealed multiple granulomatous lesions and areas of caseous necrosis surrounded by Langerhans giant cells and epithelioid cells. Conclusion: It is worth noting that in cases of ascites and pleural thickening, especially in patients with poor socioeconomic status, simultaneous pleural and peritoneal TB should be considered, especially in third-world countries. [ABSTRACT FROM AUTHOR]

Introduction: Isoniazid is a drug for treatment of tuberculosis. One of the main side effects of this drug is hepatotoxicity, which is a major cause of treatment interruption in tuberculosis. This study is about the preventive effect of Salep on this side effect of isoniazid., Materials and Methods: This study is an experimental study in which the preventive effect of salep on isoniazid hepatotoxicity is evaluated. In this study 56 rats were randomly placed in 7 eight members groups including: control group, sham, isoniazid and four isoniazid/salep groups. At the end of the study the laboratory criteria and histological features of liver toxicity were compared in different mentioned groups., Results: Significant lower serum levels of liver enzymes, billirubin, MDA and TOC; and significant higher levels of TAC and total proteins, were revealed in isoniazid/salep group in compare to isoniazid alone group.In addition, histological studies had not showed liver injury in isoniazid/salep group, while there was significant liver injury in isoniazid alone group., Conclusions: Orchid extract (salep), probably because of its antioxidant properties, prevent the destructive effects of isoniazid on the liver.