An Atypical Presentation of Tuberculous Ascites, Severe Hyponatremia, and Acute Kidney Injury in a Young Male

A 25-year-old male who had been in good health before presenting with right lower lobe pneumonia, severe hyponatremia (Na 117 mEq/L), distension, and reduced urine output. AKI secondary to acute glomerulonephritis (GN) or interstitial nephritis was suggested by the initial workup. He was discharged for outpatient nephrology follow-up following initial stabilization with hypertonic saline and intravenous fluids; however, 2 days later, he was readmitted due to worsening fever and ascites. Tuberculous peritonitis was confirmed by paracentesis, which also showed an AFB smear and TB PCR-positive ascitic fluid. Clinical improvement led to the initiation of antitubercular therapy (ATT). This case emphasizes that TB should be considered in the differential diagnosis of unexplained ascites and AKI even in immunocompetent patients without pulmonary symptoms, and that ascitic fluid PCR is a critical diagnostic tool in endemic regions.