Extrapulmonary Tuberculosis (TB) Mimicking Meigs' Syndrome: A Case Report

Meigs' syndrome is characterized by the triad of a benign ovarian tumor, ascites, and pleural effusion, with resolution of fluid collections following tumor removal. However, a range of other pelvic pathologies can mimic this presentation, sometimes referred to as pseudo-Meigs' syndrome. Extrapulmonary tuberculosis (EPTB) should be carefully considered as an important differential diagnosis in TB-endemic regions. We report the case of a 34-year-old woman who presented with progressive abdominal distension, epigastric discomfort, and shortness of breath. Clinical examination and imaging revealed ascites, a large left-sided pleural effusion, and a complex adnexal mass, raising concerns for intra-abdominal malignancy or Meigs' syndrome in the presence of elevated cancer antigen 125 (CA-125). Thoracoscopy with pleural biopsy was performed, which showed necrotizing granulomatous inflammation. Cytology of ascitic and pleural fluid demonstrated lymphocytic predominance without malignant cells, and microbiological cultures were negative. EPTB was diagnosed based on clinical, radiological, and histological findings. A nine-month course of standard anti-tubercular medications was started and demonstrated significant clinical recovery, including resolution of symptoms, weight gain, and radiological improvement. This case illustrates how EPTB can closely mimic pseudo-Meigs' syndrome, emphasizing the importance of considering TB in patients from endemic regions presenting with ascites, pleural effusion, and adnexal masses, even in the presence of raised tumor markers. Early biopsy and multidisciplinary evaluation are key to avoiding misdiagnosis and ensuring timely and effective treatment.