Difficulty in the differential diagnosis of peritoneal carcinomatosis and tuberculosis in a young female patient with ascites: a case report

Abstract

The differential diagnosis between peritoneal tuberculosis and peritoneal carcinomatosis is quite challenging because of the similarity of the clinical picture and laboratory and instrumental examination data. Peritoneal tuberculosis and peritoneal carcinomatosis may present with the development of ascites, lymph nodes, and intestinal loop conglomerates. This article presents the clinical case of a young patient who, after her second childbirth, noted the appearance of intense pain in the neck and between the scapulae. Two months later, she experienced pneumonia with a positive reaction to antibiotic therapy. After another 2 months, she experienced recurrent ascites and gastrointestinal symptoms for the first time. The examination revealed ovarian masses and signs of peritoneal carcinomatosis and lung nodules. However, the clinical presentation was atypical for peritoneal carcinomatosis, and lung lesions were suspicious for tuberculosis, which allowed us to hypothesize the presence of tuberculosis of multiple localizations. The diagnosis was confirmed by laparoscopy with a biopsy of the involved tissues and subsequent histological and laboratory confirmation of the etiological role of Mycobacterium tuberculosis. The described case demonstrates the importance of using all available diagnostic methods to establish the causes of ascites in young female patients for differential diagnosis between specific and neoplastic etiologies.

Keywords

tuberculosis of multiple localizations / peritoneal tuberculosis / tuberculosis of abdominal organs / peritoneal carcinomatosis / ascites / case report

References

[1] Hopewell PC, Jasmer RM. Overview of clinical tuberculosis. In: Tuberculosis and the tubercle bacillus. 2004:13–31. doi: 10.1128/9781555817657.ch2

[2] Hopewell P.C., Jasmer R.M. Overview of clinical tuberculosis. In: Tuberculosis and the tubercle bacillus. 2004. P. 13–31. doi: 10.1128/9781555817657.ch2

[3] Hopewell PC, Jasmer RM. Overview of clinical tuberculosis. In: Tuberculosis and the tubercle bacillus. 2004:13–31. doi: 10.1128/9781555817657.ch2

[4] Oge T, Ozalp SS, Yalcin OT, et al. Peritoneal tuberculosis mimicking ovarian cancer. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012;162(1):105–108. doi: 10.1016/j.ejogrb.2012.02.010

[5] Oge T., Ozalp S.S., Yalcin O.T., et al. Peritoneal tuberculosis mimicking ovarian cancer // European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012. Vol. 162, N 1. С. 105–108. doi: 10.1016/j.ejogrb.2012.02.010

[6] Oge T, Ozalp SS, Yalcin OT, et al. Peritoneal tuberculosis mimicking ovarian cancer. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012;162(1):105–108. doi: 10.1016/j.ejogrb.2012.02.010

[7] Nissim O, Ervin FR, Dorman SE, Jandhyala D. A Case of Peritoneal Tuberculosis Mimicking Ovarian Cancer in a Young Female. Case Reports in Obstetrics and Gynecology. 2022;2022. doi: 10.1155/2022/4687139

[8] Nissim O., Ervin F.R., Dorman S.E., Jandhyala D. A Case of Peritoneal Tuberculosis Mimicking Ovarian Cancer in a Young Female // Case Reports in Obstetrics and Gynecology. 2022. Vol. 2022. doi: 10.1155/2022/4687139

[9] Nissim O, Ervin FR, Dorman SE, Jandhyala D. A Case of Peritoneal Tuberculosis Mimicking Ovarian Cancer in a Young Female. Case Reports in Obstetrics and Gynecology. 2022;2022. doi: 10.1155/2022/4687139

[10] Zhou XX, Liu Y-L, Zhai K, Shi H-Z, Tonga Z-H. Body fluid interferon-γ release assay for diagnosis of extrapulmonary tuberculosis in adults: a systematic review and meta-analysis. Scientific Reports. 2015;5(1):15284. doi: 10.1038/srep15284

[11] Zhou X.X., Liu Y.-L., Zhai K., Shi H.-Z., Tonga Z.-H. Body fluid interferon-γ release assay for diagnosis of extrapulmonary tuberculosis in adults: a systematic review and meta-analysis // Scientific Reports. 2015. Vol. 5, N 1. P. 15284. doi: 10.1038/srep15284

[12] Zhou XX, Liu Y-L, Zhai K, Shi H-Z, Tonga Z-H. Body fluid interferon-γ release assay for diagnosis of extrapulmonary tuberculosis in adults: a systematic review and meta-analysis. Scientific Reports. 2015;5(1):15284. doi: 10.1038/srep15284

[13] Barber MS, Aronson JK, von Schoen-Angerer T, et al. CARE guidelines for case reports: explanation and elaboration document. Translation into Russian. Digital Diagnostics. 2022;3(1):16–42. doi: 10.17816/DD105291

[14] Barber M.S., Aronson J.K., von Schoen-Angerer T., и др. Рекомендации CARE для описания случаев: разъяснения и уточнения // Digital Diagnostics. 2022. Т. 3, № 1. C. 16–42. doi: 10.17816/DD105291

[15] Barber MS, Aronson JK, von Schoen-Angerer T, et al. CARE guidelines for case reports: explanation and elaboration document. Translation into Russian. Digital Diagnostics. 2022;3(1):16–42. doi: 10.17816/DD105291

[16] Gudu W. Isolated ovarian tuberculosis in an Immuno-competent woman in the post partum period: case report. Journal of Ovarian Research. 2018;11:1–4. doi: 10.1186/s13048-018-0472-2

[17] Gudu W. Isolated ovarian tuberculosis in an Immuno-competent woman in the post partum period: case report // Journal of Ovarian Research. 2018. Vol. 11. P. 1–4. doi: 10.1186/s13048-018-0472-2

[18] Gudu W. Isolated ovarian tuberculosis in an Immuno-competent woman in the post partum period: case report. Journal of Ovarian Research. 2018;11:1–4. doi: 10.1186/s13048-018-0472-2

[19] Chen IH, Torng P-L, Lee C-Y, et al. Diagnosis of peritoneal tuberculosis from primary peritoneal cancer. International Journal of Environmental Research and Public Health. 2021;18(19):10407. doi: 10.3390/ijerph181910407

[20] Chen I.H., Torng P.-L., Lee C.-Y., et al. Diagnosis of peritoneal tuberculosis from primary peritoneal cancer // International Journal of Environmental Research and Public Health. 2021. Vol. 18, N 19. P. 10407. doi: 10.3390/ijerph181910407

[21] Chen IH, Torng P-L, Lee C-Y, et al. Diagnosis of peritoneal tuberculosis from primary peritoneal cancer. International Journal of Environmental Research and Public Health. 2021;18(19):10407. doi: 10.3390/ijerph181910407

[22] Maheshwari A, Gupta S, Rai S, et al. Clinical and laboratory characteristics of patients with peritoneal tuberculosis mimicking advanced ovarian cancer. South Asian Journal of Cancer. 2021;10(2):102–106. doi: 10.1055/s-0041-1736030

[23] Maheshwari A., Gupta S., Rai S., et al. Clinical and laboratory characteristics of patients with peritoneal tuberculosis mimicking advanced ovarian cancer // South Asian Journal of Cancer. 2021. Vol. 10, N 2. P. 102–106. doi: 10.1055/s-0041-1736030

[24] Maheshwari A, Gupta S, Rai S, et al. Clinical and laboratory characteristics of patients with peritoneal tuberculosis mimicking advanced ovarian cancer. South Asian Journal of Cancer. 2021;10(2):102–106. doi: 10.1055/s-0041-1736030

[25] Zhou R, Qiu X, Ying J, et al. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis. Frontiers in Public Health. 2022;10:938544. doi: 10.3389/fpubh.2022.938544

[26] Zhou R., Qiu X., Ying J., et al. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis // Frontiers in Public Health. 2022. Vol. 10. P. 938544. doi: 10.3389/fpubh.2022.938544

[27] Zhou R, Qiu X, Ying J, et al. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis. Frontiers in Public Health. 2022;10:938544. doi: 10.3389/fpubh.2022.938544

[28] EL-Deeb M, Malwany HEL, Khalil Y, Mourad S, et al. Interferon Gamma Release Assays (IGRA) in the Diagnosis of Active Pulmonary Tuberculosis. Journal of High Institute of Public Health. 2014;44(1):33–40. doi: 10.21608/JHIPH.2014.20355

[29] EL-Deeb M., Malwany H.E.L., Khalil Y., Mourad S., et al. Interferon Gamma Release Assays (IGRA) in the Diagnosis of Active Pulmonary Tuberculosis // Journal of High Institute of Public Health. 2014. Vol. 44, N 1. P. 33–40. doi: 10.21608/JHIPH.2014.20355

[30] EL-Deeb M, Malwany HEL, Khalil Y, Mourad S, et al. Interferon Gamma Release Assays (IGRA) in the Diagnosis of Active Pulmonary Tuberculosis. Journal of High Institute of Public Health. 2014;44(1):33–40. doi: 10.21608/JHIPH.2014.20355

[31] Ramanan RV, Venu V. Differentiation of peritoneal tuberculosis from peritoneal carcinomatosis by the Omental Rim sign. A new sign on contrast enhanced multidetector computed tomography. European Journal of Radiology. 2019;113:124–134. doi: 10.1016/j.ejrad.2019.02.019

[32] Ramanan R.V., Venu V. Differentiation of peritoneal tuberculosis from peritoneal carcinomatosis by the Omental Rim sign. A new sign on contrast enhanced multidetector computed tomography // European Journal of Radiology. 2019. Vol. 113. P. 124–134. doi: 10.1016/j.ejrad.2019.02.019

[33] Ramanan RV, Venu V. Differentiation of peritoneal tuberculosis from peritoneal carcinomatosis by the Omental Rim sign. A new sign on contrast enhanced multidetector computed tomography. European Journal of Radiology. 2019;113:124–134. doi: 10.1016/j.ejrad.2019.02.019

[34] Kattan J, Haddad FGh, Menassa-Moussa L, et al. Peritoneal tuberculosis: A forsaken yet misleading diagnosis. Case Reports in Oncological Medicine. 2019;2019. doi: 10.1155/2019/5357049

[35] Kattan J., Haddad F.Gh., Menassa-Moussa L., et al. Peritoneal tuberculosis: A forsaken yet misleading diagnosis // Case Reports in Oncological Medicine. 2019. Vol. 2019. doi: 10.1155/2019/5357049

[36] Kattan J, Haddad FGh, Menassa-Moussa L, et al. Peritoneal tuberculosis: A forsaken yet misleading diagnosis. Case Reports in Oncological Medicine. 2019;2019. doi: 10.1155/2019/5357049

[37] Debi U, Ravisankar V, Prasad KK, et al. Abdominal tuberculosis of the gastrointestinal tract: revisited. World Journal of Gastroenterology. 2014;20(40):14831. doi: 10.3748/wjg.v20.i40.14831

[38] Debi U., Ravisankar V., Prasad K.K., et al. Abdominal tuberculosis of the gastrointestinal tract: revisited // World Journal of Gastroenterology. 2014. Vol. 20, N 40. P. 14831. doi: 10.3748/wjg.v20.i40.14831

[39] Debi U, Ravisankar V, Prasad KK, et al. Abdominal tuberculosis of the gastrointestinal tract: revisited. World Journal of Gastroenterology. 2014;20(40):14831. doi: 10.3748/wjg.v20.i40.14831

[40] Purbadi S, Indarti J, Winarto H, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer case report: Laparoscopy as diagnostic modality. International Journal of Surgery Case Reports. 2021;88:106495. doi: 10.1016/j.ijscr.2021.106495

[41] Purbadi S., Indarti J., Winarto H., et al. Peritoneal tuberculosis mimicking advanced ovarian cancer case report: Laparoscopy as diagnostic modality // International Journal of Surgery Case Reports. 2021. Vol. 88. P. 106495. doi: 10.1016/j.ijscr.2021.106495

[42] Purbadi S, Indarti J, Winarto H, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer case report: Laparoscopy as diagnostic modality. International Journal of Surgery Case Reports. 2021;88:106495. doi: 10.1016/j.ijscr.2021.106495

[43] Huang B, Cui DJ, Ren Y, et al. Comparison between laparoscopy and laboratory tests for the diagnosis of tuberculous peritonitis. Turkish journal of medical sciences. 2018;48(4):711–715. doi: 10.3906/sag-1512-147

[44] Huang B., Cui D.J., Ren Y., et al. Comparison between laparoscopy and laboratory tests for the diagnosis of tuberculous peritonitis // Turkish journal of medical sciences. 2018. Vol. 48, N 4. P. 711–715. doi: 10.3906/sag-1512-147

[45] Huang B, Cui DJ, Ren Y, et al. Comparison between laparoscopy and laboratory tests for the diagnosis of tuberculous peritonitis. Turkish journal of medical sciences. 2018;48(4):711–715. doi: 10.3906/sag-1512-147

Funding

Департамент здравоохранения города МосквыMoscow Health Care DepartmentMoscow Health Care Department(123031400009-1)

RIGHTS & PERMISSIONS

Eco-Vector