Peritoneal tuberculosis: A case report on a rare cause of tumor marker elevation

Abstract

Peritoneal tuberculosis (TB) is a rare extrapulmonary manifestation of TB with non-specific clinical characteristics which can produce test results mimicking malignancy and granulomatous peritonitis. This case describes a Filipino 59-year-old, nulliparous woman who was admitted with abdominal pain, ascites, and an elevated CA-125 level. Radiographically, peritoneal nodules were visualized and initial suspicion was high for malignancy. Following a bilateral salpingo-oophorectomy and peritoneal biopsy, histology was negative for malignancy but revealed non-caseating granulomas. She was discharged then readmitted with progressive abdominal pain, and a repeat laparoscopic biopsy yielded specimens with growth of acid-fast bacilli (AFB). A delay in diagnosis and treatment of tuberculous peritonitis increases mortality rates, making early diagnosis with laparoscopic biopsy of paramount importance in prompt diagnosis and initiation of therapy. This patient was initiated on standard anti-TB therapy and experienced no complications.

Peritoneal and Pulmonary Tuberculosis in a Postpartum Female with Elevated Cancer Antigen 125 and Ascites

“…A positive AFB smear and culture for Mycobacteria on the ascitic fluid establishes the diagnosis of PT [ 3 ]. However, the ascitic fluid AFB smear and cultures are often negative, and because of the slow AFB growth rate, it may take as long as 8 weeks for the culture to become positive [ 11 ]. Cell counts from the ascitic fluid analysis usually demonstrate a lymphocytic predominance [ 3 , 9 , 12 ].…”

“…Definitive diagnosis of PT requires invasive diagnostic testing [ 1 ]. The gold standard is a laparoscopic peritoneal biopsy with pathological and microbiological confirmation [ 2 , 11 ], especially in patients who do not present with ascites. The sensitivity of peritoneal biopsy is 85–100% [ 9 ].…”

“…Peritoneal TB is occasionally associated with involvement of the ovaries, and this can cause an elevated CA-125 [ 2 , 4 – 6 , 11 , 18 ], which is also sensitive, but nonspecific ovarian tumor marker. CA-125 also can be elevated in pulmonary and extrapulmonary tuberculosis.…”