Therapeutic pneumoperitoneum in a patient with pulmonary tuberculosis and persistent fever

• Published in: BMJ case reports Vol. 2011; no. jan29 1; p. bcr0520102968
• Main Authors: Antoniou, M, Chloros, D, Spyratos, D, Giouleka, P, Sichletidis, L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 02.02.2011; BMJ Publishing Group
• Series: Unexpected outcome (positive or negative) including adverse drug reactions
• Subjects: Adult; Antitubercular Agents - therapeutic use; Chemotherapy; Combined Modality Therapy; Drugs; Europe (East); Female; Fever - etiology; Humans; Neutrophils; Pneumoperitoneum, Artificial; Tuberculosis; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - therapy; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.05.2010.2968

Artificial pneumoperitoneum represents a therapeutic technique first applied in the treatment of pulmonary tuberculosis (TB) in prechemotherapy antimycobacterial era. A 25-year-old patient presented with pulmonary TB diagnosed during the 8th month of her pregnancy. She was febrile and in severe clinical condition. An antituberculous regimen of four primary drugs was initiated immediately after the caesarean section. There was no clinical improvement after 3 months despite full drug sensitivity of Mycobacterium tuberculosis isolates. An artificial pneumoperitoneum was applied along with the drug treatment for 6 months. Soon the patient became afebrile, her body weight increased and sputum smears gave negative results. The combination of the old technique of therapeutic pneumoperitoneum along with the current antituberculosis treatment proved to be effective in this advanced case of pulmonary TB initially unresponsive to drug therapy alone.