Jornal de relatos de casos clínicos

Imaging Findings of Granulomatous Peritonitis in a Female Patient Presenting with Erythema Nodosum- A Case Report

Abstract

Eugen Divjak, Mirjana Vukelic Markovic, Ana Gudelj Gracanin, Kristijan Cupurdija, Mario Tadic and Boris Brkljacic

Granulomatous peritonitis may occur as a consequence of a disseminated infection, as a reaction to foreign materials or rupture of an intraabdominal mass or hollow viscus, or as a very rare postoperative complication. Cases of non-infectious granulomatous peritonitis are usually related to tissue reaction to talc or cornstarch in surgical gloves. The imaging findings of this condition are usually suggestive of malignancy and can lead to misdiagnosis. We report a case of aseptic granulomatous peritonitis in a 44-year-old woman with a history of multiple abdominal surgeries, presenting with erythema nodosum. Abdominal masses were also found on imaging. The patient responded well to conservative management, and no relapse was reported in the follow-up. Erythema nodosum in this patient is considered to be a manifestation of granulomatous peritonitis that developed two months after laparotomy, and the authors weren’t able to find an earlier case report of such a clinical case. The goal of this paper is to introduce a possibly new presentation of granulomatous peritonitis. Also, the authors wanted to give a presentation of imaging appearance of this condition, otherwise rarely described in literature. This paper reminds us of importance of being aware of rare complications following abdominal surgery, as well as of conditions that can mimic intraabdominal malignancy. The proper management can be conservative and more invasive procedures can be avoided.