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December 1972

Noncaseating Tuberculous Peritonitis

Author Affiliations

Durham, NC

From the Department of Medicine, Duke University Hospitals, and Durham Veterans Administration Hospital, Durham, NC.

Arch Intern Med. 1972;130(6):920-922. doi:10.1001/archinte.1972.03650060110020

Tuberculous peritonitis is still sufficiently common to appear in the differential diagnosis of abdominal pain, fever, and ascites. Untreated, the illness has a significant mortality (45%-55%),1,2 whereas with early detection and antituberculous therapy, the outlook is favorable. Hughes et al3 observed only one death in the 26 patients (4%) they treated with chemotherapy. In the absence of pulmonary tuberculosis, the diagnosis of tuberculous peritonitis must be established histologically and the typical pathologic finding is the presence of caseating granulomas. The presence of noncaseating granulomas in the peritoneum has not previously been recognized as a component of this disease. This report redefines the pathologic findings of tuberculous peritonitis. Noncaseation is frequently alluded to, but is not documented in the literature.4

Patient Summaries 

Patient 1.  —A 60-year-old black man entered the Durham (NC) Veterans Administration Hospital with intermittent abdominal pain of several years' duration, fever of three months' duration,

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