Pelvic tuberculosis: a forgotten diagnosis – case report

Abstract

We present a case of a 14-year-old girl, Bacillus Calmette-Guérin (BCG) vaccinated, who presented with vague symptoms of abdominal pain, weight loss, and fatigue. Imaging studies revealed a pelvic mass, later found to be pelvic tuberculosis, a rare diagnosis to consider at this age. The diagnostic approach was difficult, since all investigations pointed strongly to a malignancy, from clinical, imaging (ultrasound and magnetic resonance), laboratory (elevated CA-125), and even macroscopic findings at laparotomy. Histopathology was the first hint (noncaseous granulomata), but the ultimate documentation of Mycobacterium tuberculosis relied on a persistent clinical suspicion, despite contradicting results. Surgical approach could have been mutilating, with irreversible consequences, considering it was a girl with a long reproductive life ahead. Tuberculosis is still a great masquerade, especially the extrapulmonary forms, and although infrequently seen at this age, it should thus be considered in the differential diagnosis of complex pelvic masses in order to avoid surgical iatrogeny/morbidity.

Sonographic features of pelvic tuberculosis mimicking ovarian‐tubal‐peritoneal carcinoma

“…This case report suggests that TVS findings of miliary tubercles, peritoneal carcinomatosis and Fallopian tube carcinoma may be suggestive of TB. We advise searching for these TVS features, particularly in young women who present with specific clinical characteristics and sonographic evidence of ascites and pelvic masses [1][2][3][4][5][6] . However, a combination of ultrasound and early laparoscopy are fundamental to ruling out tuberculous peritonitis in patients with peritoneal malignancy of suspected gynecological origin.…”