Peritoneal and upper genital tract tuberculosis mimicking an advanced fallopian tube carcinoma: A case report and a systematic literature review

Background:

Tuberculosis (TB) is the leading cause of death worldwide. Due to globalization and flight movements there has been an increased TB incidence in western countries. TB most commonly affects the lungs, but can also affect the reproductive organs. In women genital TB can present with chronic pelvic pain, menstrual abnormalities or infertility, but can also stay asymptomatic.

Case report:

A 23-year-old woman presented with intermittend abdominal pain, unintentional weight loss, dyspareunia and primary infertility. She had emigrated from Morocco the previous year. There was no family history for breast or ovarian cancer and no history of previous TB. CA-125 levels were elevated, HE 4 was normal, ROMA-Index: 13.2%, suggesting a high risk for epithelian ovarian cancer (EOC). Ultrasound revealed free fluid, dilated fallopian tubes and a cystic mass near the right ovary. Suspecting fallopian tube or ovarian cancer, we performed an exploratory laparoscopy that revealed adhesions, multiple miliary nodes and dilated fallopian tubes. Histological investigation revealed granulomatous abscessificated salpingitis with suspicion of genital TB. Acid-fast stain and culture were negative for Mycobacterium tuberculosis. We started antituberculous therapy. CA-125 levels returned to normal and the patient is currently asymptomatic.

Conclusion:

Female genital TB is an important differential diagnosis for diverse pelvic processes, since symptoms can vary widely, and should be kept in mind regarding suspected of fallopian tube or ovarian carcinoma to prevent women from extensive surgery. To avoid invasive diagnostics, an algorithm for possible differentiation between peritoneal/female genital TB and EOC may be helpful in clinical setting.