Pelvic-peritoneal tuberculosis presenting as an adnexal mass and mimicking ovarian cancer

Diagnosis of pelvic- peritoneal tuberculosis is often difficult, because of its nonspecific clinical, laboratory and radiological findings. The presence of an adnexal mass, ascites, and raised CA 125 level, may be mistaken as ovarian malignancy. Peritoneal tuberculosis should be considered in the differential diagnosis of adnexal masses, ascites and elevated CA 125. Ascitic fluid adenosine deaminase (ADA), polymerase chain reaction (PCR) for Mycobacterium tuberculosis and endometrial biopsy may help to distinguish pelvic-peritoneal tuberculosis from ovarian malignancy. Peritoneal tuberculosis can be managed by antituberculosis therapy (ATT), therefore these test should be performed before surgery to exclude peritoneal tuberculosis, so that invasive and expensive surgery could be avoided.