BACKGROUND: Mycobacterium tuberculosis is the most common cause of tuberculosis in the world. Since the mid-1980s the United States has seen an increase in the incidence of tuberculosis, attributed largely to an increase in patients infected with HIV and to the immigration of infected individuals from endemic areas. The disease affects mainly the lungs, but about one-third of patients also have involvement of other sites. The incidence of peritoneal tuberculosis is low in developed countries and is the sixth most common extrapulmonary site. Laparoscopic biopsy provides a rapid and definitive diagnosis. When promptly diagnosed, tuberculosis is one of the few diffuse peritoneal processes for which there is effective therapy with an excellent prognosis. CASE: A 20-year-old woman with a diffuse peritoneal process and elevated CA-125, suspected to be secondary to ovarian cancer, as diagnosed as having tuberculosis peritonitis. Diagnostic laparoscopy was invaluable in establishing the diagnosis. CONCLUSION: Use of CA-125 for diagnosis of ovarian cancer may lead to misdiagnosis and unnecessary, invasive procedures. Suspecting and establishing a diagnosis by laparoscopic biopsy may prevent unnecessary laparotomy.
BACKGROUND:Mycobacterium tuberculosis is the most common cause of tuberculosis in the world. Since the mid-1980s the United States has seen an increase in the incidence of tuberculosis, attributed largely to an increase in patients infected with HIV and to the immigration of infected individuals from endemic areas. The disease affects mainly the lungs, but about one-third of patients also have involvement of other sites. The incidence of peritoneal tuberculosis is low in developed countries and is the sixth most common extrapulmonary site. Laparoscopic biopsy provides a rapid and definitive diagnosis. When promptly diagnosed, tuberculosis is one of the few diffuse peritoneal processes for which there is effective therapy with an excellent prognosis. CASE: A 20-year-old woman with a diffuse peritoneal process and elevated CA-125, suspected to be secondary to ovarian cancer, as diagnosed as having tuberculosis peritonitis. Diagnostic laparoscopy was invaluable in establishing the diagnosis. CONCLUSION: Use of CA-125 for diagnosis of ovarian cancer may lead to misdiagnosis and unnecessary, invasive procedures. Suspecting and establishing a diagnosis by laparoscopic biopsy may prevent unnecessary laparotomy.