Healed tuberculosis left an adolescent with ascites that kept coming back

A late-adolescent boy was diagnosed with extrapulmonary tuberculosis after fever, weight loss and enlarged lymph nodes in the chest and retroperitoneum. His course was complicated by drug-induced liver injury and a tubercular psoas abscess that needed percutaneous drainage.

After the drainage, milky chylous ascites kept returning quickly, requiring frequent large-volume paracentesis. Prolonged antitubercular therapy, dietary changes and octreotide did not stop it. Magnetic resonance lymphangiography showed lymph leaking from retroperitoneal vessels near the right kidney, and the thoracic duct was not visualised beyond the cisterna chyli. The authors interpreted this as obstruction from healed tuberculous lymphadenitis.

Intranodal lymphatic embolisation with a glue-lipiodol mixture led to sustained resolution of the ascites. This is a single case report, so it cannot show how often this works or how generalisable the approach is.