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Primary abdominal tuberculosis presenting as chronic dyspepsia

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To the Editor: Tuberculosis (TB) continues to be a leading cause of preventable morbidity and mortality worldwide. Although Australia has the lowest rates in the world, more recently there has been a spike secondary to increased international travel and migration.1

TB can affect virtually any organ system in the body and can present with atypical or non-specific symptoms. A population-based study in America found that classical symptoms of cough and fever of > 2 weeks’ duration and weight loss were variably present and were insensitive predictors for TB.2

A 51-year-old immunocompetent man who had migrated from Somalia 18 years previously presented with a 6-year history of being treated with proton pump inhibitors for chronic duodenal ulcers. Repeated gastroscopies showed oedematous thickened duodenum. He had a 6-month history of anorexia, nausea, vomiting and weight loss, and was referred for diagnostic laparoscopy for suspected gastrointestinal malignancy.

A computed tomography scan of the abdomen showed small coeliac axis lymph nodes and oedematous thickened duodenum (Box). Gastroscopic biopsy samples over the past 6 years had shown chronic inflammation but no granulomas. Laparoscopy showed florid peritoneal nodules suggestive of miliary TB. A biopsy sample was positive for polymerase…