Molecular diagnosis of an unusual aetiology of chronic abdominal pain with ascites.
Anas MohamedKen LinRouzan KarabakhtsianKristina ChackoRachel BartashQiang LiuEric MeyerowitzPublished in: BMJ case reports (2024)
An immigrant woman in her 60s with a complex medical history and remote occupational exposure to patients with tuberculosis (TB) presented with abdominal pain, early satiety, bloating and weight loss. Physical exam showed abdominal distention and ascites. Diagnostic paracentesis revealed low serum ascites albumin gradient and elevated ascitic lymphocytic count. However, fluid cytology, bacterial and mycobacterial cultures were negative. An interferon-gamma release assay for TB was indeterminate. MRI of the abdomen and pelvis showed a thickened endometrial stripe. Endometrial biopsy demonstrated non-caseating granulomatous endometritis. No organisms were identified on Grocott methenamine silver or acid-fast bacilli special stains. A tissue block from the endometrial biopsy submitted for DNA sequencing was positive for mycobacterium tuberculosis (MTB) complex Urine mycobacterial cultures were obtained and the patient was started on isoniazid, rifampin, ethambutol and pyrazinamide, with significant improvement in her symptoms. Urine mycobacterial cultures were eventually positive for pansusceptible MTB.
Keyphrases
- mycobacterium tuberculosis
- abdominal pain
- fine needle aspiration
- cell free
- ultrasound guided
- pulmonary tuberculosis
- endometrial cancer
- weight loss
- gram negative
- circulating tumor
- case report
- single cell
- healthcare
- bariatric surgery
- magnetic resonance imaging
- single molecule
- gold nanoparticles
- high throughput
- physical activity
- mental health
- dendritic cells
- contrast enhanced
- multidrug resistant
- rheumatoid arthritis
- interstitial lung disease
- diffusion weighted imaging
- sleep quality
- depressive symptoms
- peripheral blood
- gastric bypass
- magnetic resonance
- silver nanoparticles
- idiopathic pulmonary fibrosis
- hiv aids
- obese patients
- hepatitis c virus
- electronic health record
- systemic sclerosis