SHM Converge Scientific Abstract ePoster Gallery-Unmasking Peritoneal Tuberculosis Behind a Suspicious Ovarian Mass

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This case describes a 36-year-old woman from Papua New Guinea who presented with abdominal distention, early satiety, and diffuse abdominal pain. Imaging showed ascites, omental nodularity, a right adnexal mass, and a pleural effusion, while CA-125 was markedly elevated, making ovarian malignancy a strong initial concern. However, gynecologic examination did not reveal a clear adnexal lesion, and cytology from thoracentesis and paracentesis was negative for malignancy.<br /><br />Because peritoneal tuberculosis can closely mimic ovarian cancer, especially in patients from TB-endemic regions, further evaluation was pursued. Initial QuantiFERON testing was indeterminate, and AFB stains and cultures from pleural, peritoneal, and sputum samples were negative. The definitive diagnosis came from exploratory laparotomy and peritoneal biopsy, which showed prominent granulomas with a single acid-fast bacillus, and PCR testing confirmed Mycobacterium tuberculosis complex DNA.<br /><br />The patient was diagnosed with peritoneal tuberculosis and treated with standard anti-tubercular therapy: isoniazid, rifampin, pyrazinamide, and ethambutol for two months, followed by isoniazid and rifampin for four additional months. Gynecologic oncology, infectious disease, and public health officials helped coordinate care.<br /><br />This case highlights the diagnostic difficulty of peritoneal tuberculosis, which often presents with nonspecific symptoms and imaging findings that resemble ovarian cancer. It emphasizes the importance of considering TB in patients with unexplained ascites and malignancy-like features, particularly when epidemiologic risk factors are present, to avoid unnecessary invasive cancer-directed procedures and ensure timely treatment.

Asset Subtitle

Dominika Moscicka

Meta Tag

Author List Amanda Stephens, Dominika Moscicka, Gizem Reyhanoglu

Category Clinical Vignettes

Concept Dry Adhesive Tuberculous Peritonitis

Concept Peritoneal Biopsy

Concept Histopathology

Concept Microbiologic Confirmation

Concept Anti-tuberculosis Regimen

Distinguished Non-Finalist

Presenter Organization FSU Internal Medicine Residency Program

Presenting Author Dominika Moscicka

Track Adult

Keywords

peritoneal tuberculosis

ovarian malignancy mimic

ascites

omental nodularity

CA-125 elevation

pleural effusion

granulomatous inflammation

acid-fast bacillus

Mycobacterium tuberculosis complex

anti-tubercular therapy

Dry Adhesive Tuberculous Peritonitis

Peritoneal Biopsy

Histopathology

Microbiologic Confirmation

Anti-tuberculosis Regimen