Peritoneal Tuberculosis and Chronic Myeloid Leukaemia: A Case of Hickam's Dictum

Abstract

We report the case of a 34-year-old male with persistent fever, ascites, thrombocytosis and clinical deterioration despite broad-spectrum therapy who was ultimately diagnosed with peritoneal tuberculosis and concurrent chronic myeloid leukaemia. Initial investigations, including interferon-γ release assay and ascitic acid-fast bacilli, were negative, highlighting the limited sensitivity of traditional testing in extrapulmonary disease. Diagnosis required molecular testing and adenosine deaminase measurement, with delayed confirmation by culture. Bone marrow aspirate and trephine, pursued to broaden the differential diagnosis, revealed a Philadelphia chromosome. This case underscores the need for sustained diagnostic vigilance, multimodal investigation and avoidance of diagnostic parsimony.