A patient with tuberculous peritonitis with very high serum CA 125: Figure 1

Seo, Bong Soo; Hwang, In Kyeom; Eun, Ji; Kim, Yong Sung

doi:10.1136/bcr-2012-006382

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…endometriosis, pancreatitis, peritonitis, IBD) conditions [20]. Notably, increased Ca125 serum levels have been reported in both PTB and pulmonary TB and Ca125 can also be used for monitoring anti-TB treatment response [21,22].…”

Section: Discussionmentioning

confidence: 99%

Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report

Rossi¹,

Melone²,

Turco³

et al. 2020

Ital J Pediatr

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Background: Ascites can develop as a consequence of a number of diseases in childhood. Despite chronic liver disease is the most common cause, several conditions can lead to ascites also in the absence of liver dysfunction. As non-cirrhotic ascites shows a high degree of overlapping sign and symptoms it is still a challenge for physicians. Case presentation: A 8-year-old Caucasian girl was referred for fever, vomit and diarrhea occurred over the past few weeks. Physical examination showed timpanitic distension of the abdomen with marked tenderness and increased abdominal wall rigidity. Abdominal imaging showed diffuse ascites and thickened omentum and bowel wall. Blood tests showed increased C-reactive protein levels and decreased lymphocyte count. Specific treatment for inflammatory bowel disease was started. Persisting of ascites required additional investigations. Positive tuberculin skin test and Interferon Gamma release assay (IGRA) as well as increased Ca125 serum concentrations were found. Computed tomography scan showed mediastinal and mesenteric adenopathies and diffuse smooth thickening of the omentum with significant enhancement (omental cake-like). Ascitic fluid analysis revealed high leucocytes and protein levels. Presumptive diagnosis of peritoneal tuberculosis (PTB) was made. Antituberculous treatment resulted in the resolution of ascites and normalization of lymphocyte count and Ca125 serum concentrations. Conclusions: PTB is still possible in low-prevalence countries. As it is a great mimicker of other abdominal pathology whose treatment might worsen tuberculosis progression, clinical suspicion and adequate screening are required to avoid unnecessary interventions and delayed treatment. Ca125 is a non-specific marker of peritoneal inflammation but it might be helpful in monitoring the treatment response.

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Section: Discussionmentioning

confidence: 99%

Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report

Rossi¹,

Melone²,

Turco³

et al. 2020

Ital J Pediatr

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“…4 CA 125 is a soluble glycoprotein oncofetal antigen that was found in coelomic epithelium during fetal development. CA 125 is widely recognized and utilized in monitoring recurrence of epithelial ovarian cancer, treatment responsiveness, and to distinguish malignant from benign pelvic masses.…”

Section: Discussionmentioning

confidence: 99%

“…CA 125 is widely recognized and utilized in monitoring recurrence of epithelial ovarian cancer, treatment responsiveness, and to distinguish malignant from benign pelvic masses. 4,5 For premenopausal women, CA 125 levels are usually elevated with benign gynecologic condition such as fibroid, benign ovarian cysts, and endometriosis. Terada et al published a study stating that menopausal females with an elevated CA 125 and without ovarian cancer are associated with increased risk of premature mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Although tumor markers are useful for cancer screening, diagnosis, monitoring treatment effectiveness, and recurrence, it should be interpreted appropriately and carefully due to the possibility of elevation in the benign conditions. 4 CA 125 is a soluble glycoprotein oncofetal antigen that was found in coelomic epithelium during fetal development. CA 125 is widely recognized and utilized in monitoring recurrence of epithelial ovarian cancer, treatment responsiveness, and to distinguish malignant from benign pelvic masses.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Peritoneal Tuberculosis Mimicking Malignancy

Swe

Naing

Phyo

et al. 2016

Journal of Investigative Medicine High Impact Case Reports

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Our search of literature revealed combined elevations of serum cancer antigen 125 levels and rheumatoid factor levels in a patient with peritoneal tuberculosis has rarely been reported. Thus, we describe the case of a 63-year-old female with large abdominal ascites and malignancy was ruled out with biopsy. High levels of serum cancer antigen and rheumatoid factor were noted. Physicians should be aware that tuberculosis infection could induce elevation of rheumatoid factor levels in the absence of rheumatologic symptoms or disease. A high index of suspicion is required because peritoneal tuberculosis is a great mimicker of other abdominal pathology, especially intraabdominal malignancies and can mislead physicians to undergo unnecessary interventions.

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“…10 Many reports have reported an association between peritoneal tuberculosis and high serum CA 125. 11,12 In addition, elevated serum CA 125 levels have a high predictive value for a diagnosis of peritoneal tuberculosis, whereas decreased serum CA 125 levels can be used to evaluate the efficacy of therapy in peritoneal tuberculosis. 3,[11][12][13] Some studies reported that while the serum CA 125 levels may be elevated in patients with peritoneal tuberculosis (approximately 10-to 20-fold higher than normal values), they would likely be much higher in patients with peritoneal carcinomatosis (approximately 60-fold higher than normal values).…”

mentioning

confidence: 99%

Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125

2019

Korean J Gastroenterol

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A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

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A patient with tuberculous peritonitis with very high serum CA 125: Figure 1

Cited by 4 publications

References 9 publications

Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report

Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report

A Rare Presentation of Peritoneal Tuberculosis Mimicking Malignancy

Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125

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