Discussion: This is a case of active peritoneal TB infection in a man treated with an anti-tumor necrosis factor alpha (anti-TNF) monoclonal antibody. Screening for active TB and latent TB infection (LTBI) is mandatory prior to the initiation of treatment with anti-TNF drugs. However, there is no consensus on how patients should be monitored for active TB infection once started on an anti-TNF drug. Clinical manifestation of TB in patients on biologic agents if often atypical and extrapulmonary, placing them at risk for delayed diagnosis and disseminated disease. The sensitivity of QFT-GIT detecting LTBI in immunocompetent adults is 80-92%. That sensitivity decreases in active TB and immunocompromised hosts. In differentiating between TB and non-TB etiologies of ascites, fluid analysis, including ADA, can be helpful. However, the gold standard for diagnosis remains culture of ascitic fluid and/or peritoneal biopsy via laparoscopy.
Conclusions: Patients treated with anti-TNF drugs are at increased risk for primary and reactivation TB infection but more likely to have a false negative screening test result. Clinicians must maintain a high index of suspicion as such patients often present atypically.
To cite this abstract:Voaklander, R; Velickovic Ostojic, L; Chernyavsky, S . PERITONITIS: SUSPECT BUT VERIFY. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 776. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/peritonitis-suspect-but-verify/. Accessed September 17, 2019.