A 26-year-old female presents to the emergency department with 1 day of abdominal pain, vomiting and diarrhea. She is otherwise healthy and previously resided in Cameroon, where she had a history of treatment for malaria and typhoid fever. She noted severe constipation over the 2 weeks prior to her emergency department presentation, which progressed to severe diarrhea after a single bowel movement.

She endorses fatigue and night sweats, and her friends commented on noticeable weight loss. A CT of her abdomen shows diffusely thickened bowel loops with an area of tethering concerning for a closed loop obstruction. She also has mild ascites and peritoneal thickening with areas of nodularity. Surgical services are consulted and recommend further workup for malignancy. An ultrasound-guided biopsy of the peritoneal nodule is performed, and peritoneal fluid is collected. The surgical pathology of the biopsy demonstrates granulomatous inflammation with no evidence of neoplasm. An adenosine deaminase test is sent from peritoneal fluid and returns positive. Molecular testing for a specific organism, sent from the surgical pathology block, returns positive. Cultures ultimately yield growth after 21 days of incubation.  

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Author Information

Jake Karsten, MT(ASCP), Technical Specialist, Microbiology Laboratory, Mayo Clinic Ariz.
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