A rare case of genital tb, mimicking malignancy, with refractory ascites

Tuberculosis, especially in developing countries is a major health problem, and causes significant morbidity and mortality. It is estimated that Genital Tb affects about 12% of women with pulmonary Tuberculosis (PTB) and 15 to 20% of women with Extra-Pulmonary T.B(1). The commonest sites involved in the cases of genital T.B. are the fallopian tubes (90–100%), followed by endometrium (50–80%) and the ovaries (20–30%) (3). The classical presentation is a triad of infertility, menstrual irregularity & chronic pelvic pain. Isolated ovarian tuberculosis presenting as an adnexal mass can mimick ovarian tumor and is extremely rare condition. Because of its uncharacteristic presentation, TB should also be considered in the differential diagnosis of a patient with an abdominal/pelvic mass and ascites (7). It should be kept in mind that diagnostic imaging tests are also non-specific and both USG and CT/MRI scan appearances are similar in ovarian tuberculous abscess and other neoplastic ovarian masses (4).In genital Tb, the clinical presentation mimic malignancy which was also evident in our case, where provisional diagnosis of ovarian tumor was made on the basis of history given by the patient, clinical examination, radiographic findings and elevated CA-125 serum levels. An elevated CA-125 level is also found in some of the patients with ovarian tuberculosis which further increases the diagnostic dilemma (1, 4, 10). Thus, diagnosis of TB is no easy task, as the symptoms are non-specific and mimicks gynaecological malignancy.