Primary duodenal tuberculosis masquerading as chronic liver disease : an unusual presentation

Primary involvement of the duodenum by tuberculosis (TB) occurs infrequently. It poses diagnostic challenges owing to rarity, nonspecific clinical features and equivocal imaging results (1-3). As per literature, the usual presentation is in the lines of gastrointestinal obstruction, upper gastrointestinal bleeding or acid- peptic disorders (2-4). The diagnosis is sometimes established even intra-operatively during exploratory laparotomy (3). The authors describe an unusual case of a 43-years old woman with primary duodenal TB, with features mimicking chronic liver disease (CLD). She complained of diffuse pain abdomen and abdominal distension followed by bilateral leg swelling for about a month. Treated as a case of CLD elsewhere, but without any improvement, she was referred to our centre. There was no history of recurrent vomiting, diarrhoea, fever, weight loss, cough, dyspnoea, rashes or arthralgia. Past history of TB, diabetes and hypertension was absent. The general examination documented: temperature 37.20C, blood pressure 90/60 mmHg, pulse 96 beats/ minute, respiratory rate 20 breaths/ minute, oxygen saturation 100% at room air, moderate pallor and bilateral pitting pedal edema. The abdomen was soft on palpation with mild diffuse tenderness, and fluid thrill was present. Respiratory system examination detected dullness on percussion in bilateral infrascapular areas with decreased air entry. The remainder of the clinical examination was unremarkable.