A Typical Presentation of Tuberculosis in Cirrhosis

A 44-year old woman with Child –Pugh A cirrhosis presented with large-volume ascites. Laboratory indices showed an international normalized ratio of 1.7, a bilirubin level of 90 umol/L, WCC of 8.4 × 109/L, and an albumin level of 29 g/dL. Ascitic fluid analysis showed a WCC of 35 cells/mm3, culture and cytology were negative, and the serum albumin-ascites gradient was 9 g/dL. Cross-sectional imaging showed no hepatocellular carcinoma or pathologic lymphadenopathy. A computed tomography–positron-emission tomography scan (Figure A) showed intense uptake of a thickened peritoneum consistent with a metabolically active process.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Image of the Month Source Type: research