Disseminated Peritoneal Tuberculosis Mimicking Metastatic Ovarian Cancer

S. Nasir H. Zaidi, MD, PhD, Michael Conner, MD, From the Department of Pathology, University of Alabama at Birmingham

South Med J. 2001;94(12) 

In This Article

Abstract and Introduction

A 41-year-old woman had a 2-week history of low-grade fever, associated with gradually increasing abdominal pain and girth. Ultrasonography showed a complex cystic right adnexal mass. Diffuse nodules (0.1 to 0.5 cm) were found at exploratory laparotomy involving the serosal surfaces of the uterus, fallopian tubes, and ovaries. She had a total abdominal hysterectomy, with bilateral salpingo-oophorectomy and omentectomy for presumed stage IIIC ovarian carcinoma. Histopathologic examination showed chronic granulomatous inflammation with no evidence of neoplasm. Special stains on tissue sections and ascitic fluid were negative for fungi and mycobacteria. Additional history indicated a recently positive PPD skin test (within 6 months), followed by isoniazid therapy for 4 months. Polymerase chain reaction (PCR) done on paraffin-embedded tissues produced evidence of Mycobacterium tuberculosis. Ascitic fluid cultures became positive for M tuberculosis at 6 weeks. The patient was placed on four-drug antituberculous therapy and had a complete recovery.

It is estimated that about 8 million new cases of Mycobacterium tuberculosis infection occur each year worldwide, and 95% of these are in underdeveloped nations. About 3 million people die of this disease each year. If left untreated, about 50% would die within 5 years.[1,2,3]

The developed world (including the United States) had a dramatic reduction in the incidence of M tuberculosis infection after the early 1950s, mainly due to reduction in overcrowding and availability of effective antibiotics. Since 1986, however, the incidence of M tuberculosis infection in the United States has been rising, largely because of the increase of persons infected with the human immunodeficiency virus (HIV), immigration of infected individuals from endemic areas, and social problems such as poverty, homelessness, and drug abuse. The disease mainly affects the lung, but about one third of patients also have involvement of other organs, such as meninges, bone, joints, genitourinary tract, and abdominal cavity.[1,2,3]

Peritoneal/abdominal tuberculosis is still common in underdeveloped countries. Its incidence is low in developed countries (sixth most common extrapulmonary site), but an increasing number of cases have been identified with the recent rise in the incidence of M tuberculosis infection.[4,5,6,7] Peritoneal infection is commonly manifested by abdominal pain, ascites, diarrhea, fever, weight loss, and anemia. The clinical, radiologic, and laboratory (elevated CA-125 levels) presentation is often confused with peritoneal carcinomatosis.[5,6,7,8] Laparoscopically directed biopsy and histologic and PCR tests provide a rapid and definitive diagnosis.[8,9] When promptly diagnosed, it is one of the few diffuse peritoneal processes for which there is effective therapy, with an excellent prognosis.

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