Journal of Gynecology and Reproductive Health
ISSN: 2574-2728 | DOI: 10.64030/2574-2728
Sarah Werner, Fareed Rajack, Mohamed Desouki, Luxue Deng, Katherine Mager, Karen McLean, Nicole Gaulin and Peter Frederick
Background: Peritoneal tuberculosis is a disseminated form of mycobacterium tuberculosis infection that results in peritoneal thickening, abdominopelvic masses, ascites and elevated CA 125 that can mimic advanced stage gynecologic malignancy and while it is a rare diagnosis accounting for approximately 5% of all TB cases globally, a multidisciplinary approach is required for timely diagnosis and appropriate treatment. We hope that this will serve as a reminder to broaden the differential when faced with these findings and no underlying malignancy.
Case: We report a case of a 46-year-old healthy female who presented with abdominal pain, ascites and peritoneal thickening. Initial abdominal imaging revealed ascites and omental caking and carcinomatosis. Elevated cancer antigen 125 (CA-125) levels to 639 units per milliliter (U/mL) further raised suspicion of a gynecological malignancy. Multiple omental biopsies did not yield malignant tissue and subsequent investigations with Karis cell free DNA ultimately led to an unanticipated diagnosis and appropriate treatment.
Conclusion: Peritoneal tuberculosis (TB) is an uncommon diagnosis. This case highlights the critical role of histological analysis when radiological findings suggest malignancy; as well as the importance of utilizing a multidisciplinary approach for a comprehensive workup when the diagnosis is uncertain. Usage of cell free DNA assisted in accurate diagnosis is crucial for timely and appropriate management. Following treatment initiation, serial CT scans should be used for monitoring and to guide the duration of anti-tuberculous therapy.