PERITONEAL TUBERCULOSIS CAN TRIGGER NEW ONSET DIABETES MELLITUS IN A POSTPARTUM WOMAN

Shashwati Sen, Harish Srivastav, Kamal Singh, Gautam Sen.

Mohak Hospital, Prayagraj, India

 

 

OBJECTIVE:

New onset Type-1 Diabetes mellitus (DM) can develop in a postpartum woman with peritoneal tuberculosis (TB).

 

CASE REPORT:

A young lactating primipara with BMI 21, presented 3 months after caesarean section with abdominal distention and fever for 1 week. There was no bleeding or discharge per vaginum. Her antepartum and postpartum history was insignificant. 

Investigations showed raised blood sugar (582 mg/dl) and moderate ascites. Ascitic tap reported lymphocytosis and elevated proteins (4.5g/dl). The patient was started on Insulin and Antitubercular treatment (ATT) followed by a remarkable improvement in 9 months. 

2 years later, a laparoscopic evaluation for secondary infertility was performed which showed bilateral blocked fallopian tubes with loss of fimbria and dense adhesions. 

Histopathology of a paratubal nodule filled with cheesy material showed caseous necrosis and a fibrous wall infiltrated by lymphocytes, epithelioid cells, few histiocytes and an occasional Langhan’s giant cell confirming tuberculosis (Fig.1 and Fig.2). Endometrial biopsy was normal.

The patient continues to be on Insulin 3 years after diagnosis. She has been counselled for Assisted Reproductive Technique (ART) in view of bilateral blocked tubes

RESULT:

Inflammation because of uterine involution and Caesarean section, delays the recovery of immune function for 3-4 months postpartum. A weakened immune system makes the patient prone to tuberculosis. Peritoneal TB may induce pancreatitis leading to diabetes.

 

CONCLUSION:

India has the highest number of TB patients in the world. According to India TB Report, the state of Uttar Pradesh has the largest share of TB patients (20%). The postpartum woman has a weakened immune system in the initial 3-4 months after delivery which makes her susceptible to TB. Pancreatitis is a rare but serious complication of peritoneal TB which needs early diagnosis and aggressive management.