Abbassi Hafedh, Guerbej Ekram, Bannour Badra, Bannour Imen, Nfikha Zeineb, Boughizane Sassi, Mokni Moncef, Khairi Hedi
University of Sousse, Faculty of Medicine of Sousse, Department of Gynecology and Obstetrics, Farhat Hached Teaching Hospital, Sousse, Tunisia.
University of Sousse, Faculty of Medicine of Sousse, Pathology Department, Farhat Hached Teaching Hospital, Sousse, Tunisia.
Radiol Case Rep. 2025 Mar 8;20(5):2588-2593. doi: 10.1016/j.radcr.2025.02.012. eCollection 2025 May.
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.
腹膜结核（PT）是肺外结核的一种罕见形式，在突尼斯等流行地区，因其与晚期卵巢癌相似，给诊断带来了挑战。我们报告了一名28岁女性的病例，她没有个人或家族癌症或结核病史，表现为全身腹痛、发热、厌食、体重减轻和腹胀。影像学检查显示有腹水、左侧附件包块、腹膜结节以及血清CA-125水平升高（790 U/mL），这使得人们怀疑是腹膜结核、腹膜癌转移或晚期卵巢癌。腹腔镜检查证实有多个腹膜结节和腹水。组织病理学检查显示为坏死性肉芽肿性炎症，尽管齐-尼氏染色结果为阴性，但结核聚合酶链反应确诊了该病。患者对抗结核治疗（ATT）有反应，症状和影像学表现完全缓解。该病例强调，在流行地区，对于有附件包块、腹水和CA-125水平升高的年轻女性进行鉴别诊断时，需要考虑腹膜结核。通过微创腹腔镜检查进行早期组织病理学确诊可以避免不必要的手术，并实现及时治疗。
