Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 2 , Pages 164-167, June 2005

Tuberculous Peritonitis Associated with Ovarian Teratoma Presenting as Peritoneal Carcinomatosis

  • Chun-Yuan Su

      Affiliations

    • Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Yuh-Cheng Yang

      Affiliations

    • Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
    • Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
    • Department of Mackay Nursing School, Taipei, Taiwan
    • Department of Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr. Yuh-Cheng Yang, Department of Obstetrics and Gynecology and Department of Medical Research, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei, Taiwan
    • ,
  • Chin-Yuan Tzen

      Affiliations

    • Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Jen-Ruei Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan

Received 14 July 2004; received in revised form 15 July 2004; accepted 15 July 2004.

Article Outline

Summary 

Objective

Peritoneal tuberculosis (TB) is a fatal disease if not promptly diagnosed. We present a case of unexplained ascites with miliary peritoneal TB and a review of the literature.

Case Report

A 56-year-old woman was admitted to our hospital because of severe abdominal fullness for 20 days. Computed tomography scans of the abdomen showed massive ascites and a huge intrapelvic mass mimicking an ovarian dermoid cyst. Laboratory examinations revealed an elevated serum cancer antigen 125 level of 1,132.9 IU/mL and normal chest roentgenographic findings. About 5 L of ascitic fluid and many superficial whitish miliary deposits on the intra-abdominal and pelvic surfaces were found during exploratory laparotomy. A right ovarian cystic mass measuring 15 × 14 × 10 cm in size was noted and removed. Pathologic studies of the cyst revealed a mature cystic teratoma, and all the specimens from the peritoneum and the ovarian surface had chronic granulomatous inflammation with central caseous necrosis compatible with TB. She received postoperative anti-TB chemotherapy and was doing well 5 months after surgery.

Conclusion

Tuberculous peritonitis is not easy to diagnose. We suggest that tuberculous peritonitis associated with ovarian teratoma should be included in the differential diagnosis of peritoneal carcinomatosis.

Key Words:  ascites , ovarian teratoma , tuberculous peritonitis

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Panoskaltsis TA , Moore DA , Haidopoulos DA , McIndoe AG . Tuberculosis peritonitis: part of the differential diagnosis in ovarian cancer . Am J Obstet Gynecol . 2000;183:740–742
  2. Simsek H , Savas MC , Kadayifci A , Tatar G . Elevated serum CA 125 concentration in patients with tuberculous peritonitis: a case-control study . Am J Gastroenterol . 1997;92:1174–1176
  3. Shakil AO , Korula J , Kanel GC , Murray NG , Reynolds TB . Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease: a case control study . Am J Med . 1996;100:179–185
  4. Marshall JB . Tuberculosis of the gastrointestinal tract and peritoneum . Am J Gastroenterol . 1993;88:989–999
  5. Nafeh MA , Medhat A , Abdul-Hameed AG , Ahmad YA , Rashwan HM , Strickland GT . Tuberculous peritonitis in Egypt: the value of laparoscopy in diagnosis . Am J Trop Med Hyg . 1992;47:470–477
  6. Burgess LJ , Swanepoel CG , Taljaard JJ . The use of adenosine deaminase as a diagnostic tool for peritoneal tuberculosis . Tuberculosis . 2001;81:243–248
  7. Hillebrand DJ , Runyon BA , Yasmineh WG , Rynders GP . Ascitic fluid adenosine deaminase insensitivity in detecting tuberculous peritonitis in the United States . Hepatology . 1996;24:1408–1412
  8. Ribera E , Martinez Vasquez JM , Ocana I , et al.   Diagnostic value of ascites gamma interferon levels in tuberculous peritonitis. Comparison with adenosine deaminase activity . Tubercle . 1991;72:193–197
  9. Valdes L , San Jose E , Alvarez D , et al.   Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme, and interferon gamma . Chest . 1993;103:458–465
  10. Ogawa K , Koga H , Hirakata Y , Tomono K , Tashiro T , Kohno S . Differential diagnosis of tuberculous pleurisy by measurement of cytokine concentrations in pleural effusion . Tuber Lung Dis . 1997;78:29–34
  11. Sathar MA, Simjee AE, Coovadia YM, Soni PN, Moola SA, Insam B, et al. Ascitic fluid gamma interferon concentrations and adenosine deaminase activity in tuberculous peritonitis . Gut . 1995;36:419–421
  12. Lye WC . Rapid diagnosis of Mycobacterium tuberculous peritonitis in two continuous ambulatory peritoneal dialysis patients, using DNA amplification by polymerase chain reaction . Adv Perit Dial . 2002;18:154–157
  13. Matlow AG , Harrison A , Monteath A , Roach P , Balfe JW . Nosocomial transmission of tuberculosis (TB) associated with care of an infant with peritoneal TB . Infect Control Hosp Epidemiol . 2000;21:222–223

PII: S1028-4559(09)60131-5

doi:10.1016/S1028-4559(09)60131-5

Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 2 , Pages 164-167, June 2005

Article Tools