Figure 2

Peritoneal TB with non-necrotizing granulomas. A 51-year-old man from the Philippines presented with a two-year history of early satiety, intractable abdominal pain, and weight loss exceeding 60 pounds. Abdominal CT showed evidence of “peritoneal carcinomatosis.” (A) Peritoneal biopsy showed no evidence of malignancy. Instead, there were multiple non-necrotizing granulomas (demarcated by red dashed lines) with prominent Langhans-type multinucleated giant cells (arrows) and surrounding fibrosis (asterisks) (H&E). The boxed inset shows a magnified view of the smaller box demonstrating the multinucleated giant cells. (B) A peritoneal lymph node biopsy showed similar non-necrotizing granulomatous inflammation (white dashed line) with a conspicuous multinucleated giant cells (white arrow) (H&E). The acid-fast stain in both the peritoneal and lymph node biopsies were negative. With standard treatment for drug-susceptible TB, his symptoms abated and he regained his lost body weight. TB, tuberculosis.