Peritoneal Tuberculosis: A Forsaken Yet Misleading Diagnosis

Abstract

In women presenting with an abdominal mass and ascites, the first diagnosis to consider is ovarian cancer. However, clinicians should always consider alternative differentials, namely, peritoneal tuberculosis, especially in the presence of respiratory symptoms and with the increasing prevalence of extrapulmonary tuberculosis. Peritoneal tuberculosis can mimic the clinical presentation of ovarian cancer, and on imaging, it can show similar features of peritoneal carcinomatosis and nodules. Tumor markers can also be elevated in the absence of malignancy. We present the case of a 44-year-old woman with abdominal distension and ascites. Imaging with CT scan, MRI, and PET scan were inconclusive, showing peritoneal nodules. Cytology of ascites was negative. Laparoscopy was done showing Koch bacilli followed by pulmonary sampling showing Mycobacterium tuberculosis. The patient was treated with quadritherapy with resolution of symptoms.

An uncommon presentation of extrapulmonary tuberculosis masquerading as ovarian malignancy in a young female

“…reported a case of middle-aged woman where conventional imaging and PET CT were inconclusive with peritoneal nodules, however, Histopathological examination (HPE) confirmed M. tuberculosis . [ 15 ] Similar findings were also reported by Takalkar et al . in a case report of a 29-year-old woman with abdominal pain.…”

Case Series: Various Radiologic Findings of Peritoneal Tuberculosis Mimicking Malignancy and Pathological Confirmation

“…Although the volume of ascitic fluid could be various, minimal or massive. Sometimes, it just only loculated ascites (8). Ascites on PTB are a thick exudate fluid with a density (20-45 HU) on a CT scan (4).…”

“…CT Scan is a very important modality to establish the diagnosis of PTB (7). However, PTB can deceive clinicians and cause misdiagnosis (8). Several reports state that the abdominal enlargement of reproductive age women is sometimes suspected of ovarian cancer, this is related to the clinical symptoms that appear (5).…”

“…Several reports state that the abdominal enlargement of reproductive age women is sometimes suspected of ovarian cancer, this is related to the clinical symptoms that appear (5). The radiologist should to be realize that PTB as one of the differential diagnoses of any young adult patients with intra-abdominal mass, even the CT scan findings are mimicking malignancy (8).…”

Tuberculous peritonitis

“…1 The possibility of miliary tuberculosis should be considered when ascites with peritoneal thickening is present along with pleural effusion. 2 A delay in the diagnosis and treatment of tuberculosis increases patient mortality, suggesting that an early diagnosis by laparoscopic biopsy is very important for a prompt diagnosis and initiation of treatment. 3 Contributors HK and HI researched the topic and wrote the case.…”