A Diagnostic Dilemma: Acute Myeloid Leukemia Masquerading as Surgical Abdomen Mimicking Abdominal Tuberculosis: A Case Report

Acute myeloid leukemia (AML) is a hematopoietic malignancy that typically presents with constitutional symptoms, cytopenias, and bleeding manifestations. Its presentation as a surgical abdomen with ascites is exceedingly rare. Tuberculosis manifesting as peritoneal ascites is more commonly seen in the context of tuberculosis-endemic countries such as India. We report the case of a 19-year-old male who presented to our institute with abdominal pain and distension, unintentional weight loss, and easy fatigability, leading us to suspect peritoneal tuberculosis. Investigations were also in favor of tuberculosis, with elevated levels of adenosine deaminase (ADA). However, the presence of atypical lymphoid cells in the ascitic fluid led us to further evaluate the patient and come to a diagnosis of AML after extensive investigations. This case highlights a rare but critical diagnostic dilemma wherein AML presents with ascites and findings that closely mimic abdominal tuberculosis. This case is presented owing to its rare clinical presentation.