[Active pelvic-peritoneal tuberculosis with ascites and very high CA-125 level--a case report]

We report the case of a 62-year-old woman who presented with a 2-week history of fever, abdominal pain and ascites. Her serum CA-125 level was very high (1070 U/ml), that in addition to clinical finding and ultrasonography suggested genital malignancy. Unexpectedly, the diagnosis of pelvic-peritoneal tuberculosis was reached by hystopathology after abdominal hysterectomy with bilateral adnexectomy. Cultures of ascitic fluid taken on admission grew Mycobacterium tuberculosis six weeks later. Serum levels of CA-125 returned to normal during antituberculous drug treatment. This observation should help clinicians to entertain a differential diagnosis of pelvic-peritoneal tuberculosis in patients with ascites and raised CA-125 serum levels, and in some cases to prevent unnecessary laparotomy. Moreover, it indicates that his tumour marker, widely used to monitor patients undergoing treatment for ovarian cancer, may be also used to follow disease activity in non-neoplastic ascitic states, particularly to monitor response to treatment of pelvic-peritoneal tuberculosis.