A 56-year-old woman had suffered from abdominal fullness for three months. She had had poor appetite, general malaise, nausea and vomiting two weeks earlier, but denied tarry stool or diarrhea. She had lost about 6 kg over 3 months. Abdominal sonography revealed ascites. Laboratory data showed normocytic anemia, with hemoglobin 10.3 g/dL (normal range, 12-16 g/dL), and CA-125 level elevated to 188.6 U/mL (normal range, <35 U/mL). Abdominopelvic CT revealed multiloculated ascites in her abdomen and pelvis, thickened peritoneum, strandings in the omentum, small mesenteric nodules, enlarged mesenteric and paraaortic lymph nodes, prominent ovaries, and dilated fallopian tubes (Figure 1(Fig. 1)). There was no evidence of soft tissue in the ileocecal region. Under the initial diagnosis of ovarian cancer with carcinomatosis peritonei, she was admitted and exploratory laparotomy was performed. The operative findings included small nodules in the peritoneum, omentum, small bowel loops, uterus, and fallopian tubes and severe adhesions between bowel loops, the left ovary, and the pelvic side wall. The tentative diagnosis was carcinomatosis peritonei, so left salpingo-oophorectomy, enterolysis and peritoneum biopsy was performed.
The final diagnosis from the biopsy was tuberculosis peritonitis. Microscopic sections showed granulomatous inflammation with central caseous necrosis, epithelioid histiocytes and Langhans giant cells in the ovary, fallopian tube, and peritoneum (Figure 2A(Fig. 2)). Mycobacterial bacilli were also demonstrated by acid-fast stain (Figure 2B(Fig. 2)).