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Miliary TB-mimicking advanced ovarian cancer with osteolytic lesions of the spine

Abstract number: R2344

Ntinos K., Astriti M., Sarri K., Bounas P., Adamis G., Isopoulos T., Littos M., Gargalianos P.

Objective: to present a case of miliary TB mimicking advanced ovarian cancer with thoracic spine metastases.

Results: A 24-year old Somalian female complained for backache, constipation and low grade fever for the last 5 months. Basic laboratory tests revealed anemia (Hb = 9.7 mg/dl) and severe thrombocytosis (PLT = 1027×103). She also had an elevated CA-125 of 982 U/ml (<35U/ml) and a positive tuberculin test (17 mm). She underwent C/T scan which revealed pleural effusions, ascites, a solid lesion of the right ovary and osteolytic and slerosing lesions of the lower thoracic vertebrae, and transvaginal ultrasound which showed a large cystic mass arising from the right ovary. Paracentesis of the ascites was performed; the fluid was an exudate with positive cytology for atypic cells, possibly adenocarcinoma, and negative for AFB. Gastroscopy and barium enema were normal. As the above findings suggested of an advanced ovarian cancer, laparotomy was performed; the macroscopic picture was of multiple whitish lesions over the peritoneum and the intestines (omental cake). Two liters of ascetic fluid were removed and an ADA test was done which came back positive: 55U/ml (13–23U/ml). The right ovary and salpynx were removed; the biopsy showed granulomatous tissue. C/T guided biopsy of the vertebral lesions was performed, and PCR for Myc. tuberculosis on the material was done which was positive. The patient was put on anti-TB treatment with isoniazid, rifampicin, pyrazinamid, and ethambutol with gradual improvement.

Conclusions: As TB is rare in the developed world, ovarian and peritoneal TB is often misdiagnosed as advanced ovarian cancer, leading young women to unnecessary laparotomy and surgery. Ascites, peritoneal nodules and elevated CA-125, even in the presence of osteolytic lesions of the vertebrae, do not necessarily indicate malignancy. Tuberculosis should always be suspected, especially in young women from endemic countries. As cultures for mycobacterium are time consuming tests, and peritoneal fluid is often negative for AFB, PCR and ADA are useful tools for the differential diagnosis.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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