A 38-year-old Liberian female with a 12-week gestation presented to the emergency department with a 3-week history of low-grade subjective fever, night sweats, unintentional weight loss, gradually worsening abdominal pain, and intermittent spotting. Vital signs were stable on presentation, physical exam noticeable for gravida abdomen, otherwise unremarkable. Laboratory examination revealed beta hCG 118471, which was otherwise unremarkable. Pelvic ultrasound confirmed a 12-week viable intrauterine pregnancy. The patient was admitted to the hospital for close monitoring. Hospital course was complicated by massive pleural effusion, low-grade fever, progressive worsening abdominal pain, and spontaneous abortion. Non-contrast-enhanced computed tomography of the chest (Figure 1) revealed large right-sided pleural effusion, and contrast-enhanced computed tomography of the abdomen and pelvis (Figure 2) revealed bilateral hilar adenopathy, ascites, thickening and enhancement of the peritoneum, and mottled nodular-appearing soft tissue consistent with omental caking suspicious for peritoneal carcinomatosis. She underwent extensive workup including surgical and oncologist consultations for possible exploratory laparotomy and discussion of treatment options for presumed ovarian neoplasm. Blood work revealed elevated carbohydrate antigen (CA) 125 and positive QuantiFERON-TB Gold, but adenosine deaminase, CA 19, alpha-fetoprotein, and inhibin B were within normal limits. Diagnostic laparoscopy with biopsy revealed significant pelvis ascites and diffuse miliary lesions throughout the peritoneum. She underwent dilatation and curettage; histopathologic examination showed chronic granulomatous inflammation with no evidence of neoplasm. Special stains on tissue sections and ascitic fluid stain revealed rare acid-fast bacilli, suggestive of mycobacterial granulomatous peritonitis. Additional questioning indicated a history of positive PPD skin test a year prior without follow-up treatment. The patient was placed on four-drug anti-tuberculous therapy and had a complete recovery.