A 37-year old woman, multiparous, of low socioeconomic status, was referred to our department at 23 weeks gestation for ascites. The patient reported a notion of abdominal volume increase one month ago, with night-sweat, anorexia, weight loss and abdominal pain which increases in intensity for subsequent weeks. Clinical examination revealed no fever, weight at 52Kg and height 1m60, (BMI= 20, 3), her abdomen was distended, diffused dullness on percussion, without pathological masses.
Laboratory investigation showed mild normochrom and normocytic anemia (Hemoglobin level 10,6g/dl) without leucocytosis. Abdominal ultrasound (Figure 1, Figure 2) showed intra-abdominal fluid, mainly in the lowest abdomen, and a thickened peritoneum. No ovarian mass was indentified on ultrasound. A chest X -ray showed no active lesion or old lesion compatible with pulmonary tuberculosis. A tuberculin skin test was positive. Acid-fast bacilli in sputum were not seen on sputum microscopy (Ziehl Nielson stain).
A peritoneal laparoscopic biopsy was performed to confirm the diagnosis. About 2.5 liter of straw-colored ascitis fluid was removed from the abdomen, there were multiple extensive nodules with central necrosis on the peritoneal surface and milary deposits on the intestine. Excision biopsy was taken from the peritoneal lesions. The final histologic report confirmed chronic granulomas with caseous necrosis and multinucleated giant cells. The patient received antituberculous chemotherapy regimen with rifampicin (R), isoniazid (H), pyrazinamide (Z) for two months and 4 months of RH.
The general condition of the patient improved significantly and she was discharged from the hospital on postoperative day 15. The pregnancy continued without any problem, prenatal ultrasonographic findings showed a single fetus in a cephalic presentation and biometric measurements were consistent with the date of pregnancy. The patient gave birth to a healthy infant of 3200Kg at 37th week's gestation by vaginal delivery.