Female genital tract tuberculosis presenting as ovarian cancer
On Jan 2009, A 47-year-old menopausal woman (gravid 8, para 8) was admitted to the department of gynecology at Ghaem University Hospital, with the complaints of gross hematuria and weight loss. She suffered from diabetes since 15 years ago. Upon physical examination, there was a palpable, firm, fixed and non-tender mass in the left lower quadrant, and ascites was also noticeable, also. An ultrasound study showed a 22 × 26 cm cystic mass with internal echoes, as well as moderate ascites. Lab tests showed anemia (Hgb = 55 gl−1), Leukocytosis (WBC = 15.4 × 109 l−1), serum creatinine level = 3.1, CA-125 = 15 units per ml. Her chest X-ray was normal and TST was negative.\nRegarding the hemorrhagic diathesis of the patient, a cystourethroscopy was performed. Further, an exploratory laparotomy showed a 3 × 4 cm mass adhered to the bladder, and biopsy specimens were taken. Pathological analysis showed mucosal ulceration with considerable inflammatory response. Ten days later, she developed a productive cough not responding to conventional antibiotic therapy. She had dehiscence and purulent discharge from incision site that was culture positive for E-coli. Follow-up chest X-ray showed pleural effusion and consolidation in the right lung. Upon further evaluation, cystoscopy was successfully performed which revealed findings suggestive of bladder tuberculosis. The patient was discharged with anti-tuberculosis standard therapy. One year later, she had no symptoms, and her CXR and abdominal ultrasound were normal.