Thread: What's the diagnosis - confused again

A 30 year old pregnant female(G6,P5) & (21 weeks gestation) presented with history of

Abdominal swelling - 1month
Low grade fever - 1 month

On examination

Hepatomegally
Cervical and supraclavicular lymphadenopathy
Pedal Edema
Ascites
Multiple bruises of different ages on body

Labs:

Ascitic fluid RE: 2.5 grams protein, 823 cell/mm3 , and 70% lymphos (tuberculous picture)
aPTT is prolong (45seconds)


Pelvic and abdominal malignancy has been ruled out.
She had taken anti tuberculous drugs for pots disease for 19 months(6 months back)
Their is no history of recurrent abortions(to rule out Antiphospholipid syndrome)

Questions:
What is the best investigation to reach a specific diagnosis?
How to calculate the resistance level of antituberculous drugs and which is the best fluid sample for that?
What is the cause of isolated aPTT prolongation in this case? (Heparin, hemophilia ruled out)


I would appreciate some help here.....

Post CBC,RFT, LFT reports first. Do ascitic fluid TB PCR also.

have you considered an eventual gestational tumor? what about pelvis IRM/US?


kind regards
dave

it's TB perotinitis < frm my point of view >