Unmasking the Imitator: Peritoneal Tuberculosis in the Guise of Ovarian Carcinoma: A Case Report

Peritoneal tuberculosis (TB) is a form of extrapulmonary TB that primarily affects areas such as the omentum, liver, intestines, spleen, and female reproductive organs. Diagnosing peritoneal TB can be challenging, as its presentation often resembles that of advanced ovarian conditions. Among the estimated 10 million TB cases worldwide, India has the highest number, with 2.8 million cases. In this case, a 14-year-old female presented with abdominal pain, distention, weight loss, and amenorrhoea. She had elevated CA-125 levels and left-sided pleural effusion observed on X-ray. An ultrasound showed significant ascites, and a contrast-enhanced CT scan of the abdomen and pelvis revealed widespread peritoneal thickening, marked ascites, and necrotic lymph nodes in the mesentery. A diagnosis of peritoneal TB was considered, and a biopsy of peritoneal deposits confirmed TB without malignancy. The patient was treated with anti-tubercular drugs, leading to substantial clinical improvement on follow-up. In cases presenting with massive ascites and high CA-125 levels without ovarian enlargement, clinicians should consider peritoneal TB as a potential diagnosis, alongside peritoneal carcinomatosis and advanced ovarian cancer, especially in resource-limited settings. Imaging is crucial in guiding diagnosis and narrowing differential options, while ultrasound-guided biopsy with histological analysis provides definitive confirmation.