Diagnostic Features of Tuberculous Peritonitis in the Absence and Presence of Chronic Liver Disease: A Case Control Study

: To determine diagnostic features of tuberculous peritonitis (TBP) in the absence and presence of chronic liver disease. : Thirty-four patients with TBP (13 without [Group I] and 21 with chronic liver disease [Group II]) and 26 controls with cirrhosis and uninfected ascites (Group III) were studied. : The clinical features in Groups I and II were similar and all patients had elevated ascitic fluid total mononuclear cell count. In Groups I, II, and III, respectively, ascitic fluid protein was>25 g/L in 100% ( ), 70% ( ), and 0% ( ); serum-ascites albumin gradient (SAAG) was>11 g/L in 0% ( ), 52% ( ), and 96% ( ) (0% [ ], 71% [ ], and 96% [ ] after correction for serum globulin); and ascitic fluid lactate dehydrogenase (LDH) level was>90 U/L in 100% ( ), 84% ( ), and 0% ( ), respectively. In Groups I and II combined, ascitic fluid acid-fast stain was negative in all but Mycobacterium tuberculosis culture was positive in 45% ( ); peritoneal nodules occurred in 94% ( ), granulomas in 93% ( ), and positive peritoneal M tuberculosis culture in 63% ( ). : In patients with suspected TBP, ascitic fluid protein of>25 g/L, SAAG of <11 g/L and LDH of>90 U/L have high sensitivity for the disease. With coexistent chronic liver disease, a lower protein level and higher SAAG are usually not helpful but LDH>90 U/L is a useful parameter for screening. Diagnosis is best confirmed by laparoscopy with peritoneal biopsy and M tuberculosis culture.