Tuberculous polyserositis is an uncommon manifestation of extrapulmonary tuberculosis. Difficulty in bacteriological confirmation and nonspecific clinical presentation hinder early diagnosis. This case report describes a young woman with polyserositis manifestations, whose diagnosis was established through epidemiological assessment, exclusion of other diseases, and high suspicion based on ascitic fluid characteristics. A 27-year-old female patient, smoker (10 pack-years), with a history of hospitalization for pneumonia four months earlier, presented to the emergency department with pleuritic chest pain for five days. Chest CT showed enlarged mediastinal lymph nodes and bilateral laminar pleural effusion, while abdominal CT revealed a small amount of free fluid in the peritoneal cavity. During hospitalization, she developed worsening pain and increased abdominal volume. Abdominal ultrasound showed moderate ascites. Investigations included serologies for syphilis, HIV, hepatitis B and C, molecular testing for Mycobacterium tuberculosis , non-reactive autoimmune markers, transvaginal ultrasound with a large amount of fluid in the pouch of Douglas, and echocardiography showing mild pericardial effusion. Diagnostic paracentesis revealed leukocytes 320/mm³ with 74% lymphocytes, total proteins 5.5 g/dL, glucose 62 mg/dL, LDH 298 U/L, and ADA 53 U/L. Treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol was initiated. After five days, the patient was discharged with clinical improvement while awaiting ascitic fluid smear microscopy results. This case illustrates the complexity of diagnosing tuberculous polyserositis due to nonspecific presentation and difficulty in obtaining cavitary fluid for bacteriological confirmation. Pleural and pericardial effusions, although symptomatic, were insufficient in volume for collection. Exclusion of hepatic, autoimmune, and infectious causes, combined with epidemiological and socioeconomic characteristics, led to suspicion of the disease. Elevated ADA levels in ascitic fluid supported the tuberculosis hypothesis and justified treatment initiation based on clinical criteria. Polyserositis is a rare form of extrapulmonary tuberculosis with nonspecific manifestations, and RIPE therapy may be initiated based on presumptive diagnosis.
Torres et al. (Sun,) studied this question.