Disseminated peritoneal tuberculosis mimicking metastatic ovarian cancer

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.