Sclerosing encapsulating peritonitis and intra-abdominal fistulas secondary to Mycobacterium bovis from remote consumption of unpasteurized cow’s milk

Abstract

Mycobacterium bovis tuberculosis acquired in Canada is extremely rare, thanks to eradication and surveillance programs as well as to milk pasteurization practices initiated in the early twentieth century. This case report presents a case of abdominal tuberculosis in a 69-year-old Canadian-born white man presumed to be secondary to consumption of unpasteurized cow’s milk in childhood. He initially presented with non-specific abdominal symptoms and underwent extensive work-up, including CT-guided biopsy, which failed to elucidate the diagnosis. After multiple hospitalizations, he underwent exploratory laparotomy with peritoneal biopsy, from which M. bovis was cultured. Diagnosis of abdominal tuberculosis is notoriously challenging because of its long latency period and the non-specific nature of presenting symptoms. In addition, imaging similarities between abdominal tuberculosis and neoplastic processes can cause further confusion. This case highlights the diagnostic challenges of this disease while illustrating the importance of a thorough history, particularly in the context of a difficult diagnosis.