Genital-peritoneal tuberculosis: a case with different diagn
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A 21-year-old woman who presented to us with mild abdominal pain and distension that started three weeks previously. She reported regular menstrual cycle and no previous pregnancy. She had no other signs or symptoms,
chest examination was negative. She neither had past medical, surgical history nor history of recent diseases in her family.

Abdominal examination revealed a distended abdomen, lower
abdominal tenderness, no rebound tenderness. Abdominal ultrasound showed ascitis and a large complex pelvic mass, involving both adnexa, with multiple thin septa and a solid component that exhibited some vascularization in the power doppler ultrasound study. Computer tomography (CT) showed retroperitoneal lymphadenopathies and peritoneal thickening. Laboratory investigation demonstrated normal white blood cell count, mild microcytic hypochromic anemia, elevated C reactive protein, elevated CA-125. The patient was screened for human immunodeficiency virus (HIV), hepatitis B and C virus, blood, urine and stool infection and all of them resulted negative.

Interferon-gamma Release Assays test was positive and demonstrated a probable M. tuberculosis (MTB) latent infection. The author performed an ecoguided sample of ascitic fluid for a cytological, microscopic, microbiological and molecular study. The cytology revealed high lymphocyte count and rare reactive mesotelial cells, no malignant cells. Direct microscopic examination, anaerobic and aerobic cultures, Ziehl–Neelsen stain were negative. Polymerase chain reaction (PCR) for MTB complex DNA detection from ascitic fluid resulted positive. Therefore she was started on an intensive course of therapy with isoniazid, rifampicin, ethambutol, pyrazinamide for two months, followed by four months of consolidation therapy with isoniazid and rifampicin.
After 4 months, radiological exams reported no more ascitic fluid, decreasing ovaries dimension, reduction of pelvic and lomboaortic lymphadenopathies, overall reduction of peritoneal thikness. At 12 months, pelvic ultrasound demonstrated normal ovaries and no ascites.

Source:https://www.ejog.org/article/S0301-2115(20)30468-1/fulltext?rss=yes
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