Chylothorax and Chylous Ascites in A Child with Primary Lymphatic Dysplasia and Rifampicin-Resistant Tuberculosis: A Diagnostic Challenge

Abstract

Background: Chylothorax and chylous ascites are rare manifestations of tuberculosis (TB), particularly when presenting alongside underlying lymphatic disorders. We report a case of a 14-year-old female where rifampicin-resistant tuberculosis occurred with underlying primary lymphatic dysplasia. Case Presentation: A 14-year-old girl presented with a two-year history of progressive abdominal distension, shortness of breath, bilateral pedal oedema. Imaging revealed bilateral pleural effusions and ascites. Nanocolloid lymphoscintigraphy demonstrated impaired lymphatic drainage without a definite site of obstruction or leak, supporting an underlying primary lymphatic dysplasia. Analysis of pleural and ascitic fluids confirmed chylous effusions (elevated triglycerides and presence of chylomicrons). Ascitic fluid Xpert MTB/RIF confirmed the presence of Mycobacterium tuberculosis with rifampicin resistance. Conclusion: Tuberculosis is a rare but important cause of chylous effusions. This case highlights the importance of screening for TB in chylothorax and chylous ascites patients.