When peritoneal tuberculosis mimics advanced ovarian cancer: A laparoscopic case from an endemic region

Peritoneal tuberculosis (PT), a rare form of extrapulmonary tuberculosis, poses diagnostic challenges in endemic regions like Tunisia due to its resemblance to advanced ovarian cancer. We report the case of a 28-year-old woman with no personal or family history of carcinoma or tuberculosis, presenting with generalized abdominal pain, fever, anorexia, weight loss, and abdominal distension. Imaging revealed ascites, a left adnexal mass, peritoneal nodules, and an elevated serum CA-125 level (790 U/mL), raising suspicion for PT, peritoneal carcinomatosis, or advanced ovarian cancer. Laparoscopy confirmed multiple peritoneal nodules and ascitic fluid. Histopathological examination revealed necrotizing granulomatous inflammation, and TB-polymerase chain reaction confirmed the diagnosis despite negative Ziehl-Neelsen staining. The patient responded to antitubercular therapy (ATT) with complete resolution of symptoms and radiological findings. This case underscores the need to consider peritoneal tuberculosis in the differential diagnosis of young women with adnexal masses, ascites, and elevated CA-125 levels in endemic regions. Early histopathological confirmation via minimally invasive laparoscopy can avert unnecessary surgery and enable timely treatment.