Summary
Background. According to the Lithuanian Department of Statistics the increasing relative incidence of childhood tuberculosis (TB) started declining only for the last two years. The most frequent forms of childhood TB are classical primary complex and mediastinal node TB. Even in a country where TB is not scarce, extrapulmonary TB is a rare sight indeed and the accurate diagnosis of childhood TB remains a major challenge.
Case presentation. In this article we present one such case of a 13 year old patient admitted to regional hospital complained of febrile fever with chills, fatigue and headache. She denied any close contact with a person with TB. Using imaging we found fluid in peritoneum, pleural and pericardial cavities and a cystic lesion with multiple septa in abdominal cavity. Laboratory measurements were uninformative and indicating various erroneous diagnoses. Only after a biopsy of lesion was performed a diagnosis of extra pulmonary TB was formed. After diagnosing abdominal TB and TB polyserositis a successful antituberculosis treatment was started. A contact with a person with infectious TB in close environment was found only after a few months of treatment and active searching.
Discussion and conclusion. Differential diagnosis of extrapulmonary TB is extensive: from other infectious to oncological diseases. Al though delayed diagnosis only worsens the disease out comes. While one can suspect TB if you have information about close contact with a person having active TB, after positive Mantoux or y interferon test or specific changes in chest x-ray, these results were not informative at all. Conclusion: even negative TB specific tests can not exclude TB.
