An enigmatic diagnosis of abdominal tuberculosis in children: Two case reports

Diagnosing abdominal tuberculosis (TB) is challenging due to its uncommon symptoms and limited diagnostic tools, which can delay treatment and increase mortality. We present two cases of abdominal TB diagnosed using different approaches. In case 1, a 6-year-old girl with a month-long history of ascites, whose father had treatment-resistant TB, was evaluated. The tuberculin test was positive, but the Xpert MTB/RIF Ultra assay was negative. Laparoscopy revealed miliary nodules, and histopathology confirmed the presence of granulomas with Langhans giant cells. In case 2, a 1-year-old girl presented with seven months of ascites and no known TB contact. The tuberculin test was negative, but an abdominal CT scan showed hepatic TB. The in-house polymerase chain reaction (PCR) for TB targeting the IS3-like element IS987 family transposase in our laboratory was positive. Both patients were diagnosed with abdominal TB, treated with the extrapulmonary (EPTB) regimen, and showed significant improvement. Diagnosing abdominal TB is complex, requiring a thorough history and adequate examination support. This might prevent delays in treatment that potentially increase complications.