Peripartum Disseminated Extrapulmonary Tuberculosis Simulating Ovarian Carcinoma

ABSTRACT

Disseminated extrapulmonary tuberculosis is an uncommon complication of pregnancy. We present a 26-year-old multiparous immigrant from Haiti who was admitted following an extramural preterm delivery. Marked ascites was confirmed by computerized tomography, which also revealed a thickened greater omentum. These findings were considered suggestive of advanced ovarian carcinoma, although extrapulmonary tuberculosis was also considered despite negative tuberculin skin test screening. Image-guided omental biopsy demonstrated caseating granulomas substantiating the diagnosis of abdominal tuberculosis, which was later confirmed by cultures. The patient responded well to antituberculosis medications. This case describes the unusual peripartum presentation of abdominal tuberculosis simulating advanced ovarian carcinoma, and demonstrates the importance of considering extrapulmonary tuberculosis when encountering ascites and omental thickening during pregnancy despite negative tuberculin skin test screening.

Pregnancy - tuberculosis - ascites - preterm delivery - adult respiratory distress syndrome

REFERENCES

• 1 Llewelyn M, Cropley I, Wilkinson R J, Davidson R N. Tuberculosis diagnosed during pregnancy: a prospective study from London.  Thorax. 2000;  55 129-132
• 2 Jana N, Vasishta K, Saha S C, Ghosh K. Obstetrical outcomes among women with extrapulmonary tuberculosis.  N Engl J Med. 1999;  26 645-649
• 3 Tripathy S N, Tripathy S N. Tuberculosis and pregnancy.  Int J Gynaecol. 2003;  80 247-253
• 4 Raviglione M C, O'Brien R J. Tuberculosis. In: Braunwald E, Fauci AS, Hauser SL, Kasper DL, Jameson JL Harrison's Principles of Internal Medicine, 15th ed. New York; McGraw Hill 2001: 1024-1034
• 5 Cheng V C, Woo P C, Lau S K et al.. Peripartum tuberculosis as a form of immunorestitution disease.  Eur J Clin Microbiol Infect Dis. 2003;  22 313-317
• 6 Brar H S, Golde S H, Egan J E. Tuberculosis presenting as puerperal fever.  Obstet Gynecol. 1987;  70 488-490
• 7 Feinberg B B, Soper D E. Miliary tuberculosis: unusual cause of abdominal pain in pregnancy.  South Med J. 1992;  85 184-186
• 8 Yilmaz T, Sever A, Gur S, Killi R M, Elmas N. CT findings of abdominal tuberculosis in 12 patients.  Comput Med Imaging Graph. 2002;  26 321-325
• 9 Rodriguez E, Pombo F. Peritoneal tuberculosis versus peritoneal carcinomatosis: distinction based on CT findings.  J Comput Tomogr. 1996;  20 269-272