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.

Figure 1

(a) Coronal fat sat T1-weighted MR image with intravenous contrast injection showing parietal thickening of the terminal ileum (long arrow) and abdominal ascites (thick arrow). (b) CT scan showing mesenteric adenopathy (long arrow), thickening of the ileum (arrowhead), and mesenteric fluid (thick arrow).

Figure 2

(a) Pathology specimen revealing granulomatous tissue; (b) presence of multinucleated giant cells (thick arrow) and areas of necrosis (long arrow); (c) Ziehl–Neelsen staining showing a comma-shaped acido-alcohol resistant bacillus compatible with Koch bacillus (black circle).