{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:08:07Z","timestamp":1790863687283,"version":"4.1.0"},"reference-count":10,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,20]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>A boy in late adolescence presented with fever, weight loss, mediastinal and retroperitoneal lymphadenopathy, and was diagnosed with extrapulmonary tuberculosis. His clinical course was complicated by drug-induced liver injury, a tubercular psoas abscess requiring percutaneous drainage. After this procedure he developed rapidly recurring chylous ascites requiring frequent large-volume paracentesis. Despite prolonged antitubercular therapy, ascites persisted. Magnetic resonance lymphangiography demonstrated leakage from retroperitoneal lymphatics into the right perinephric region together with non-opacification of the thoracic duct beyond the cisterna chyli, suggesting lymphatic obstruction secondary to healed tuberculous lymphadenitis. Conservative measures, including dietary modification and octreotide, were unsuccessful. The patient underwent intranodal lymphatic embolisation using a glue\u2013lipiodol mixture, resulting in sustained resolution of ascites. This case highlights the complex lymphatic complications of tuberculosis and demonstrates the diagnostic and therapeutic value of advanced lymphatic imaging and embolisation in refractory chylous ascites.<\/jats:p>","DOI":"10.1136\/bcr-2026-275941","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:43:33Z","timestamp":1790862213000},"page":"e275941","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Tuberculosis and persistent chylous ascites"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9792-9163","authenticated-orcid":false,"given":"Pranjal","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Naranje","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshu","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh","family":"Kedia","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivanand","family":"Gamanagatti","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences New Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026100106252138000_19.10.e275941.1","first-page":"316","article-title":"Extrapulmonary tuberculosis","volume":"120","author":"Sharma","year":"2004","journal-title":"Indian J Med Res"},{"key":"2026100106252138000_19.10.e275941.2","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_1950_16"},{"key":"2026100106252138000_19.10.e275941.3","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.ijid.2022.09.030","article-title":"Clinicoepidemiologic considerations in the diagnosis of tuberculous lymphadenitis: evidence from a high burden country","volume":"124","author":"Assefa","year":"2022","journal-title":"Int J Infect Dis"},{"key":"2026100106252138000_19.10.e275941.4","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/bjs.1800790815","article-title":"Peripheral tuberculous lymphadenopathy: A review of 67 cases","volume":"79","author":"Thompson","year":"1992","journal-title":"J Br Surg"},{"key":"2026100106252138000_19.10.e275941.5","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.4.1177"},{"key":"2026100106252138000_19.10.e275941.6","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i40.14831"},{"key":"2026100106252138000_19.10.e275941.7","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.17297"},{"key":"2026100106252138000_19.10.e275941.8","first-page":"69","article-title":"Mycobacterial chylous ascites: report of three cases and systematic review","volume":"5","author":"Mallick","year":"2018","journal-title":"Ther Adv Infect Dis"},{"key":"2026100106252138000_19.10.e275941.9","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20211270","article-title":"Intranodal lipiodol injection for the treatment of chyle leak in children - a preliminary experience","volume":"95","author":"Gupta","year":"2022","journal-title":"Br J Radiol"},{"key":"2026100106252138000_19.10.e275941.10","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.jvir.2016.05.011","article-title":"Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization","volume":"27","author":"Hur","year":"2016","journal-title":"J Vasc Interv Radiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-275941","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:43:34Z","timestamp":1790862214000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-275941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":10,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,1]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bcr-2026-275941"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-275941","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}