Diagnosis challenges of a patient with peritoneal tuberculosis masquerading as ovarian malignancy: a case report

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Bali Medical Journal Pub Date : 2022-12-01 DOI:10.15562/bmj.v11i3.3892
Anggoro Satrio Bimantoro, U. Maimunah
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Abstract

Background: Peritoneal tuberculosis (PTB) could mimic advanced ovarian cancer cases, making its diagnosis challenging. Comprehensive and conscientious examinations for diagnosis are needed to differentiate such cases to avoid inappropriate treatment. We report a problematic diagnosis of PTB that mimic ovarian malignancy. Case Presentation: A 20-year-old female patient with history of multiple rehospitalizations, presented with complaints of abdominal pain, nausea/vomiting, low-grade fever, and weight loss in the last five months. In the first admission, patient was suspected with malignant ovarian cyst due to clinical features of malignancy with normal chest X-ray, abdominal USG suggested ovarian cyst in both ovaries, high levels of Ca125. However abdominal CT-scan showed thickening in peritoneum which suggested PTB. The patient was planned for urgent laparotomy while waiting for GenExpert result. On the second admission, patient presented with recurrent abdominal pain, GenExpert sputum and stool showed negative result, and planned for surgery but the patient refused. On the last admission, patient diagnosed with impending bowel obstruction and underwent abdominal CT-scan with contrast showed diffuse multiloculated cystic lesion in cavum pelvic and multiple prominent mesenteric lymph nodes that suggested abdominal TB with abscess in cavum pelvic. Exploratory laparotomy revealed conglomeration, pus and tubercles in the peritoneum. A TB was confirmed based on pathology and microbiology examination from tissue biopsy and pus. Conclusion: We reported patients with PTB with unspecific clinical symptoms which suspected as ovarian malignancy. This study highlights the challenges in diagnosing PTB and therefore PTB could be considered a differential diagnosis in patients suspected of ovarian malignancy in the TB endemic countries.
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腹膜结核伪装成卵巢恶性肿瘤的诊断挑战:一例报告
背景:腹膜结核(PTB)可模拟晚期卵巢癌症病例,使其诊断具有挑战性。需要对诊断进行全面和认真的检查,以区分此类病例,避免不适当的治疗。我们报告了一个有问题的PTB诊断,模拟卵巢恶性肿瘤。病例介绍:一名20岁女性患者,有多次再次住院史,在过去五个月内出现腹痛、恶心/呕吐、低热和体重减轻的症状。在第一次入院时,患者因临床特征怀疑为恶性卵巢囊肿,胸部X光检查正常,腹部USG提示双侧卵巢有卵巢囊肿,Ca125水平高。然而腹部CT扫描显示腹膜增厚,提示PTB。患者计划在等待GenExpert结果时进行紧急剖腹手术。第二次入院时,患者出现复发性腹痛,GenExpert痰和粪便显示阴性结果,计划进行手术,但患者拒绝。在最后一次入院时,患者被诊断为即将发生的肠梗阻,并接受了腹部CT扫描,对比显示盆腔腔弥漫性多房囊性病变和多个突出的肠系膜淋巴结,提示腹部结核伴盆腔腔脓肿。剖腹探查发现腹膜内有团块、脓和结节。根据组织活检和脓液的病理学和微生物学检查,确诊为肺结核。结论:我们报道了PTB患者,其临床症状不明确,怀疑为卵巢恶性肿瘤。这项研究强调了诊断PTB的挑战,因此PTB可以被视为结核病流行国家疑似卵巢恶性肿瘤患者的鉴别诊断。
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来源期刊
Bali Medical Journal
Bali Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
50.00%
发文量
8
审稿时长
3 weeks
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