Case Report A Rare Cause of Ascites-Disseminated TB with Peritonitis in a Middle-Aged Female Sahathevan Vithoosan , 1 Ponnudurai Shanjeeban, 1 Joseph Philip Anpalahan, 1 Paramarajan Piranavan , 2 Harindra Karunatilake, 1 and Ananda Jayanaga 1 1 National Hospital, Colombo, Sri Lanka 2 Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA Correspondence should be addressed to Sahathevan Vithoosan; vithoosan@gmail.com Received 23 January 2019; Revised 22 April 2019; Accepted 13 May 2019; Published 26 May 2019 Academic Editor: Yoshihiro Moriwaki Copyright © 2019 Sahathevan Vithoosan et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Disseminated tuberculosis (TB) has been increasingly recognized in adults in the recent times due to increased prevalence of immune suppression. Here we describe a case of 47-year-old female who presented with disproportionate ascites where the diagnosis of disseminated TB was delayed. Case Report. A 47-year-old previously healthy female presented with generalised body swelling with disproportionate ascites and loss of appetite and weight for four-month duration. She denied any contact or past history of TB and reported no respiratory symptoms. Physical examination revealed signifcant ascites. Tere was no lymphadenopathy or hepatosplenomegaly. Respiratory system examination was normal. Her Erythrocyte Sedimentation Rate (ESR) was above 100. Tuberculin skin test was positive with 17mm. Contrast Enhanced Computed Tomography (CECT) abdomen revealed chronic liver disease with ascites. Diagnostic laparoscopy was in favour of miliary TB and the peritoneal biopsy revealed granulomatous infammation with caseous necrosis, suggestive of TB. Te patient was started on antituberculosis treatment and subsequently improved. Conclusion. TB peritonitis due to disseminated TB should be considered in the diferential diagnosis of disproportionate ascites. Even though the diagnosis is difcult, diagnostic laparoscopy and biopsy is very helpful. It is important to have an early diagnosis since delay in treatment can be detrimental in most cases. 1. Introduction Tuberculosis (TB) is a systemic infectious disease caused by Mycobacterium tuberculosis that afects multiple tissues and organs. Because it has diverse presentations, it requires a high index of suspicion. Disseminated TB has been increasingly recognised in adults in recent times. Tis is due to the increased prevalence of immune suppression due to acquired immunodefciency syndrome (AIDS) and immunosuppres- sive therapies for various medical disorders [1]. Tuberculous peritonitis is a rare presentation of disseminated TB [2]. Tere is usually a delay of about one month from presentation to diagnosis in tuberculous peritonitis [2]. Here, we describe a case of a 47-year-old previously healthy female who presented with disproportionate ascites, where the diagnosis of dissem- inated TB was delayed. Te case highlights the importance of and difculty in diagnosing disseminated TB. 2. Case Presentation A 47-year-old previously healthy female presented with generalised body swelling, disproportionate ascites, loss of appetite, and loss of weight for four months’ duration. She denied any fever, night sweats, yellowish discolouration of the eyes, hematemesis, melena, chronic cough, and haemoptysis. She reported no history of orthopnoea and paroxysmal nocturnal dyspnoea, and her urine output remained normal. Her past medical history was not signifcant for any liver, renal, or cardiac disease. She denied any past or contact history of TB. She reported no use of alcohol or herbal medications and no intravenous drug abuse. She was in a monogamous relationship and she denied any family history of liver or renal disease. She was afebrile on admission and her vitals included a pulse rate within normal limits. On exam, she was emaciated Hindawi Case Reports in Gastrointestinal Medicine Volume 2019, Article ID 5076857, 4 pages https://doi.org/10.1155/2019/5076857