2004 Volume 56 Issue 1 Pages 5-9
Tuberculous peritonitis is rare and its incidence has been reported to be less than 1% of tuberculosis cases in Japan. We report a case of postpartum tuberculous peritonitis mimicking a malignant tumor.
The patient presented with ascites, abdominopelvic masses, and elevated serum CA125 (420 U/ml) on the 28th postpartum day after a normal delivery course. Chest X-ray findings did not indicate pulmonary tuberculosis, and neither the smear method nor culture in ascitic fluid obtained by puncture indicated a infection of Mycobacterium tuberculosis. Gallium scintigram findings, however, indicated a abnormal accumulation of garium around the navel.
When an exploratory laparotomy was performed under the probable diagnosis of malignant tumor, excessive ascites was detected and numerous small masses were found in the peritoneum and the omentum. Pathological examination of the masses revealed an epithelioid granuloma with caseation necrosis, which suggested Mycobacterium infection.
Polymerase chain reaction (PCR) for Mycobacterium tuberculosis was performed postoperatively using ascitic fluid and sputa. The PCR results were negative in the ascitic fluid, but positive in sputa. Additionally, cultures from smear and sputa samples demonstrated Mycobacterium tuberculosis and thereby confirming the diagnosis of tuberculous peritonitis. Following treatment using the 3-drug anti-tuberculosis regimen, the patient recovered with disappearance of ascites and abdominopelvic masses, and the CA125 serum level returned to the normal range. [Adv Obstet Gynecol, 56(1) : 5-9, 2004(H16.2)]
