Nonspecific Lower Abdominal Pain?
An underweight 65-year-old man was admitted to the hospital for evaluation of lower abdominal pain. Computed tomography (CT) of the abdomen revealed a small amount of ascites, peritoneal contrast enhancement, and multiple mesenteric nodules, arousing the suspicion of peritoneal carcinomatosis. An enzyme-linked immunospot assay (ELSIPOT) for mycobacterium-tuberculosis-specific T-cells was positive. Specimens of ascitic fluid and peritoneal membrane were obtained by laparoscopy. Histological examination revealed numerous epithelioid-cell granulomata, and bacterial culture confirmed the diagnosis of peritoneal tuberculosis due to Mycobacterium caprae. M. caprae causes tuberculosis in ungulates (e.g., cows, deer) and is found in the Alpine regions and elsewhere. This zoonosis can spread to man through occupational exposure (cattle farming) or through the drinking of unpasteurized milk. Our patient was asymptomatic after a classic six-month course of antitubercular therapy. His mechanism of exposure was never conclusively determined.
Dr. med. Manuel Klein, Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, email@example.com
Dr. med. Christian Wulbrand, Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg
Dr. med. Ulrich Neumaier, Medizinische Versorgungszentren Dr. Neumaier & Kollegen Regensburg
Conflict of interest statement: The authors declare that no conflict of interest exists.
Cite this as: Klein M, Wulbrand C, Neumaier U: Nonspecific lower abdominal pain? Dtsch Arztebl Int 2018; 115: 90. DOI: 10.3238/arztebl.2018.0090
Translated from the original German by Ethan Taub, M.D.