Fever, abdominal pain, and lymphocytic ascites in a young immigrant from western Africa.

Tuberculous peritonitis is an uncommon disease in countries with low tuberculosis (TB) incidence, most often affecting non-white race, foreign-born individuals. We describe a case of TB with peritoneal involvement in a 32-year-old man immigrated to Italy from Burkina Faso, who presented with a history of fever, malaise, abdominal pain and abdominal swelling. Due to its nonspecific clinical presentation and paucibacillary nature, diagnosis of tuberculous peritonitis can be challenging, and requires a high index of suspicion. This report highlights the diagnostic challenges posed by tuberculous peritonitis and emphasizes the importance of imaging (computed tomography, CT) in identifying typical findings, and the value of histological examination of tissue specimens from peritoneum or any site of suspected TB as a tool for diagnosis confirmation. Learning points - Tuberculous peritonitis is a rare disease in western countries, and should be suspected in patients at risk for TB who present with fever, abdominal pain, lymphocytic ascites. - Ascites, thickening and nodules of peritoneum and omentum (omental cake) are the commonest CT imaging findings. - The yield of microscopic examination, PCR and culture testing for Mycobacterium tuberculosis on ascitic fluid is quite low, and confirmation of diagnosis usually relies on microbiological or histological examination of biopsy specimen from peritoneum or any other site of suspected TB infection. [ABSTRACT FROM AUTHOR]