Peritoneal Tuberculosis and CA-125 Levels: Case Report and Review of 2 Cases

Tumor biomarkers such as CA-125 may be elevated in non-cancerous diseases. Two female patients, 17 and 21 years old, from the North of Lebanon were admitted to our institution with ascites and probable advanced ovarian cancer seen on ultrasound. Both patients had 2 to 3 weeks history of right lower quadrant abdominal pain, abdominal distension, fever, and weight loss. Their laboratory tests were within normal limits, except for elevated CA-125 levels of 387 and 1105 U/ml, respectively. Their tuberculin skin test indurations were 10 and 5 mm, respectively. The analysis of the ascites in both patients showed a lymphocytic exudative fluid. Their chest X-rays were normal. Their abdominal CT scans revealed an ovarian mass, ascites, and signs compatible with peritoneal carcinomatosis. Diagnostic laparoscopic procedures were performed. Biopsies of the ovaries in both patients were benign; however, biopsies of the peritoneum showed caseating granulomas compatible with tuberculosis. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis DNA detection showed positive amplification in both patients. Both were treated with four anti-tuberculous combination drugs (isoniazid, rifampin, ethambutol, pyrazinamide) for 2 months, followed by two anti-tuberculous combination drugs (isoniazid, rifampin) to complete 6 months of tuberculosis treatment. Patients responded well to treatment with resolution of clinical signs and symptoms. A follow-up at 6 months showed resolution of ascites with normal ovaries on ultrasound and a normalization of CA-125 levels [1]. In tuberculous endemic regions, peritoneal tuberculosis should always be considered in any young female patient presenting with ascites, weight loss, fever, and elevated CA-125.