Tuberculous Polyserositis- The Great Mimicker

Tuberculous polyserositis is a rare presentation of tuberculosis, often mimicking metastatic malignancy due to overlapping clinical and radiological features. A patient presenting with breathlessness, fever, weight loss, and abdominal distension was diagnosed with tuberculous polyserositis involving the peritoneum and pleura. Imaging revealed peritoneal and omental thickening, pleural effusion, and abdominal lymphadenopathy, raising suspicion of metastatic disease. Diagnostic evaluation, including pleural fluid analysis, demonstrated elevated ADA levels but negative cytology and Xpert PCR for Mycobacterium tuberculosis. A laparotomy and omental biopsy confirmed tuberculosis through histopathology and Xpert PCR testing. The patient was treated with Antituberculous Therapy (ATT) and supportive care, resulting in symptomatic improvement and discharge after 25 days. This case highlights the necessity of considering tuberculosis in patients with unexplained abdominal and pleural effusions, especially in endemic regions. Positive findings such as elevated ADA levels and imaging features of peritoneal and omental thickening were critical for diagnosis. Early initiation of ATT and supportive measures ensured a favorable outcome, emphasizing the significance of a comprehensive diagnostic strategy and prompt management in cases of tuberculous polyserositis.