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Sónia Madeira Gomes1, Catarina Gouveia1,Luís Varandas1

1 – Pediatric Infecciology department, Hospital. Dona Estefânia, CHLC- EPE Lisbon, Portugal

33rd Annual Meeting of the European Society for Paediatric Infectious Diseases, Leipzig, 12 -16 de Maio de 2015 (Poster)

We present two cases of Peritoneal Tuberculosis (PTB), a rare manifestation of extra-pulmonary tuberculosis that often presents as a diagnostic challenge.
Case Report: An 11 years-old male and 12 years-old female, previously healthy adolescents, both with an epidemiological background of tuberculosis, presented with asthenia and abdominal distension for more than 4 months. The girl mentioned weight loss and night sweats and the boy vespertine fever. Both had anemia without leukocytosis and slightly elevated inflammatory markers. Serum protein levels, renal and hepatic function were normal. HIV serology was negative. The ascitic fluid showed elevated leukocytes (predominance of lymphocytes on the boy and polymorphonuclear leucocytes on the girl), reduced glucose, high protein and LDH levels. Girl´s ADA was 251. None had neoplastic cells. Chest and abdominal CT showed “pure ascites without ileitis” and the girl had “hilar enlarged lymph nodes and a pulmonary condensation in the superior left lobe”. Mycobacterium Tuberculosis was isolated on the boy’s ascitic fluid, sensitive to all first line anti-tuberculous therapy; A presumptive diagnosis of TBP was made on the girl based on epidemiology, clinical findings and elevated ADA levels. Both patients were successfully treated with standard anti-tuberculous therapy. On long term, both are asymptomatic.
Conclusion: PTB is a difficult diagnostic due to non-specific clinical manifestations and the low cultures yield. We intend to alert for the necessity of high level of suspicion and importance of indirect findings (especially ADA levels) for diagnosis. 

Palavras Chave: peritoneal tuberculosis