Abdominal Tuberculosis: an imposter of Ovarian Carcinoma!

Authors: Prachi Rawal, Suprajna Shetty

DOI: 10.18231/j.ijogr.10877.1758862498

Keywords: Abdominal tuberculosis, Ovarian carcinoma mimic, Diagnostic dilemma

Abstract: Abdominal tuberculosis accounts for a small proportion of all tuberculosis cases, approximately 5%, but poses a significant diagnostic challenge due to its nonspecific and often deceptive clinical presentation. It is typically seen in women of reproductive age and may mimic advanced ovarian malignancy owing to features such as ascites, abdominopelvic masses, and raised serum CA-125 levels. We report an unusual case of a 76-year-old postmenopausal woman who presented with abdominal distention, a palpable mass, and anorexia. Imaging revealed a large solid-cystic abdominopelvic mass with elevated CA-125, strongly suggesting a malignant ovarian tumor. She underwent exploratory laparotomy, which revealed a large thick-walled cyst containing hemorrhagic fluid, multiple miliary deposits across the peritoneal cavity, omental caking, and atrophic pelvic organs. Surprisingly, histopathological examination confirmed chronic granulomatous inflammation consistent with tuberculosis. The patient was started on anti-tubercular therapy postoperatively and responded well. This case highlights the importance of maintaining a high index of suspicion for abdominal tuberculosis, even in elderly postmenopausal women, especially when the presentation mimics malignancy. Misdiagnosis can lead to unnecessary aggressive interventions, as seen in this case. In regions endemic for tuberculosis, it is crucial for clinicians to include abdominal tuberculosis in their differential diagnosis for adnexal masses or peritoneal carcinomatosis-like presentations, regardless of age or symptom specificity.