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Ugalde I, Pirela D, Lo Presti S, Bilderback M, Pirela A, Chan J. Fatal Pulmonary Embolism in the Setting of Immune Reconstitution Inflammatory Syndrome Attributed to Ovarian Tuberculosis. J Investig Med High Impact Case Rep 2017; 5:2324709617729690. [PMID: 28959695 PMCID: PMC5593225 DOI: 10.1177/2324709617729690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/28/2017] [Accepted: 08/04/2017] [Indexed: 11/23/2022] Open
Abstract
In developed countries, tuberculosis remains a health care challenge due to human immunodeficiency virus (HIV) and immigration from endemic regions. The Centers for Disease Control and Prevention reported 9557 new cases in 2015, with extrapulmonary involvement in 20.2% of the cases. We present a 33-year-old woman from Cape Town, South Africa, who developed abdominal pain and fever while working on a cruise ship. She sought medical where she underwent computed tomography of her chest, abdomen, and pelvis with findings suggestive of pulmonary tuberculosis and an 8.9-cm pelvic mass. HIV testing was positive and the patient was started on antiretroviral therapy. Bronchoscopy confirmed the presence of acid-fast bacilli, and she was started on rifampin, isoniazid, pyrazinamide, and ethambutol. She remained persistently febrile, raising suspicion for immune reconstitution inflammatory syndrome. However, despite empiric antibiotics, the patient remained persistently febrile, tachycardic, and on day 10 of admission she went into ventricular fibrillation and expired. Autopsy revealed an occlusive thrombus in the left main pulmonary artery in addition to necrotizing granulomata in multiple organs and bilateral tubo-ovarian abscesses. Postmortem cultures for were positive for Mycobacterium tuberculosis, all consistent with disseminated Mycobacterium tuberculosis. Although previous reports underscore the association between tuberculosis and hypercoagulability, the exact mechanism remains unknown. In this article, we report a case of disseminated tuberculosis complicated by bilateral tubo-ovarian abscesses with fatal pulmonary thrombus formation.
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Affiliation(s)
| | | | | | | | | | - Joseph Chan
- Mount Sinai Medical Center, Miami Beach, FL, USA
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Peritoneal carcinomatosis mimicking a peritoneal tuberculosis. Obstet Gynecol Sci 2015; 58:69-72. [PMID: 25629022 PMCID: PMC4303756 DOI: 10.5468/ogs.2015.58.1.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 11/24/2022] Open
Abstract
Symptoms of a peritoneal progression from ovarian cancer are nonspecific such as abdominal pain, abdominal distention and more. Many imaging studies and serum CA-125 help diagnosis. However, it is difficult to exclude the instances of the diffuse peritoneal diseases that mimic carcinomatosis. The elevated CA-125 level usually correlates with the peritoneal carcimatosis, but it is often found in other peritoneal diseases. Therefore, the pathologic confirmation is necessary because of other mimicking diseases. In our case, CA-125 levels were elevated. Abdominal computed tomography finding was suspected a peritoneal tuberculosis but the pathologic result was the peritoneal carcimatosis, eventually.
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Zhao WH, Hao M. Pelvic inflammatory disease: a retrospective clinical analysis of 1,922 cases in North China. Gynecol Obstet Invest 2014; 77:169-75. [PMID: 24556824 DOI: 10.1159/000358393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To identify the cause of pelvic inflammatory disease (PID) in Shanxi, North China. METHODS Retrospective analysis of 1,922 women with PID who underwent laparoscopy for infertility. RESULTS 1,922 cases (42.3%) of PID were detected in 4,540 cases of infertility, wherein the incidence rates of nonspecific PID and female genital tuberculosis (FGTB) were 57.9 and 42.1%, respectively. From 1985 to 1995, FGTB (25.1%) was the first reason for infertility, while from 1996 to 2006, nonspecific PID (33.9%) emerged as the most common cause of infertility. Further, FGTB (74.7%) was the major factor causing occluded fallopian tubes, followed by nonspecific PID (61.1%), and the damage of the former was more serious than the latter. CONCLUSIONS PID is the main cause of tubal infertility, but the etiology of PID has changed from FGTB to nonspecific PID in the last 10 years in Shanxi.
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Affiliation(s)
- Wei-Hong Zhao
- Department of Obstetrics and Gynecology, Shanxi Medical University Second Hospital, Taiyuan, PR China
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4
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Lu P, Li F, Wang Y, Xu C, Yu J, Zhang Y, Tang S, Liu F. Uncommon Abdominopelvic Tuberculosis in Pregnancy. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ping Lu
- Department of Obstetrics and Gynecology, ZhuCheng People's Hospital, ZhuCheng, People's Republic of China
| | - Fengzhen Li
- Department of Obstetrics and Gynecology, ZhuCheng People's Hospital, ZhuCheng, People's Republic of China
| | - Yan Wang
- Department of Obstetrics and Gynecology, ZhuCheng People's Hospital, ZhuCheng, People's Republic of China
| | - Chuanjuan Xu
- Department of Obstetrics and Gynecology, ZhuCheng People's Hospital, ZhuCheng, People's Republic of China
| | - Jie Yu
- Department of Obstetrics and Gynecology, ZhuCheng People's Hospital, ZhuCheng, People's Republic of China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, ZhuCheng People's Hospital, ZhuCheng, People's Republic of China
| | - Shengjian Tang
- Department of Surgery, WeiFang Medical University, WeiFang, Shandong, People's Republic of China
| | - Fangjun Liu
- Department of Surgery, WeiFang Medical University, WeiFang, Shandong, People's Republic of China
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Rohilla M, Chopra S, Aggrawal N, Suri V, Rajvanshi A, Acharya G. Diagnostic dilemma of adnexal mass in a postmenopausal woman. J OBSTET GYNAECOL 2012; 32:315-6. [DOI: 10.3109/01443615.2011.645919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Huang D, Carugno T, Patel D. Tuberculous peritonitis presenting as an acute abdomen: a case report. Am J Obstet Gynecol 2011; 205:e11-4. [PMID: 21354548 DOI: 10.1016/j.ajog.2011.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 01/04/2011] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
Abstract
Female genital tuberculosis is relatively rare and difficult to diagnose. Often it is mistaken for ovarian malignancy. We report a case of a young immigrant woman with acute abdominal pain.
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Aslam MF, Mukherjee P, Khulpateea N, Ghayoori R. Unusual presentation of genital tract tuberculosis. J OBSTET GYNAECOL 2010; 30:636-7. [DOI: 10.3109/01443615.2010.496499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Tuberculosis (TB) and malignancy represent global threats claiming millions of lives and inflicting formidable suffering worldwide. Surprisingly, the pathophysiological and practical implications of their co-existence have received little attention. METHODS Therefore, we sought to review the available literature on the field and identify data regarding the association between TB and malignancy in order to highlight the neglected aspects of this association and probably derive clinically useful information. We searched PubMed up to June 2008 for case reports, case series, non-comparative and comparative studies that were written in English and reported data on the occurrence of both TB infection and a neoplastic disorder in the same patient(s). The development of mycobacterial infections in patients with immunocompromized conditions is well known and was considered outside the scope of this review. EVIDENCE SYNTHESIS The synthesis of the available evidence enabled us to establish three different types of association between malignancy and TB: (i) the development of cancer on the background of a previous tuberculous infection; (ii) the concurrent existence of TB and malignancy in the same patient(s) or clinical specimen(s); and (iii) the diagnostic challenges arising from the multi-faceted presentations of these two disorders. CONCLUSION We conclude that clinicians need to be aware of the protean manifestations of TB and cancer and maintain a high index of suspicion for simultaneous and/or misleading presentations. In addition, further research is required to determine if a tuberculous infection, being similar to other chronic infections and inflammatory conditions, may facilitate carcinogenesis.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
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Jana N, Mukhopadhyay S, Dhali GK. Pelvic tuberculosis with elevated serum CA125: A diagnostic dilemma. J OBSTET GYNAECOL 2009; 27:217-8. [PMID: 17454494 DOI: 10.1080/01443610601157927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- N Jana
- Department of Obstetrics and Gynaecology, Institute of Postgraduate Medical Education and Research, 244 A.J.C. Bose Road, Kolkata 700 020, India.
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Differential Diagnosis of Gynecologic Organ-Related Diseases in Women Presenting with Ascites. Taiwan J Obstet Gynecol 2008; 47:384-90. [DOI: 10.1016/s1028-4559(09)60003-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Genital tuberculosis: a new challenge in an old disease. South Med J 2008; 101:1201. [PMID: 19005453 DOI: 10.1097/smj.0b013e318185a090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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TINELLI A, MALVASI A, VERGARA D, MARTIGNAGO R, NICOLARDI G, TINELLI R, PELLEGRINO M. Abdominopelvic tuberculosis in gynaecology: Laparoscopical and new laboratory findings. Aust N Z J Obstet Gynaecol 2008; 48:90-5. [DOI: 10.1111/j.1479-828x.2007.00800.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Neonakis I, Mantadakis E, Gitti Z, Mitrouska I, Manidakis LG, Maraki S, Samonis G. Genital tuberculosis in a tamoxifen-treated postmenopausal woman with breast cancer and bloody vaginal discharge. Ann Clin Microbiol Antimicrob 2006; 5:20. [PMID: 16948834 PMCID: PMC1570363 DOI: 10.1186/1476-0711-5-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 09/01/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female genital tuberculosis is an uncommon disease that is rarely diagnosed in developed countries. CASE PRESENTATION A 61-year-old postmenopausal woman who had undergone surgery and treated with adjuvant chemotherapy for infiltrating ductal carcinoma of the breast five years ago, presented with bloody vaginal discharge, fatigue, weight loss, and low grade fevers at night for two months. Histological examination of the endometrium, done based on the suspicion of a second primary cancer due to the tamoxifen therapy, revealed a granulomatous reaction. Liquid and solid mycobacterial cultures of the tissues were performed. Although the acid fast staining was negative, the liquid culture was positive for Mycobacterium tuberculosis. Involvement of other systems was not detected. The patient was treated with a three-drug antituberculosis regimen for 9 months and recovered fully. CONCLUSION Female genital tuberculosis is a rare but curable disease that should be included in the differential diagnosis of women with menstrual problems. Early diagnosis is important and may prevent unnecessary invasive procedures for the patient.
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Affiliation(s)
- Ioannis Neonakis
- Laboratory of Mycobacteriology, Department of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University Hospital of Heraklion, 712 01 Heraklion, Crete, Greece
| | - Elpis Mantadakis
- Department of Internal Medicine, University Hospital of Heraklion, 712 01 Heraklion, Crete, Greece
| | - Zoe Gitti
- Laboratory of Mycobacteriology, Department of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University Hospital of Heraklion, 712 01 Heraklion, Crete, Greece
| | - Ioanna Mitrouska
- Department of Thoracic Medicine, University Hospital of Heraklion, 712 01 Heraklion, Crete, Greece
| | - Louis George Manidakis
- Department of Obstetrics and Gynecology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Laboratory of Mycobacteriology, Department of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University Hospital of Heraklion, 712 01 Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, 712 01 Heraklion, Crete, Greece
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Tapisiz OL, Reyhan H, Cavkaytar S, Aydogdu T. Pelvic tuberculosis mimicking ovarian carcinoma. Int J Gynaecol Obstet 2005; 90:76-7. [PMID: 15913626 DOI: 10.1016/j.ijgo.2005.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 02/04/2005] [Indexed: 10/25/2022]
Affiliation(s)
- O L Tapisiz
- Zekai Tahir Burak Womens' Health Research and Education Hospital, Ankara, Turkey.
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Huang YJ, Wei LH, Hsieh CY. Clinical Presentation of Pelvic Tuberculosis Imitating Ovarian Malignancy. Taiwan J Obstet Gynecol 2004. [DOI: 10.1016/s1028-4559(09)60051-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lantheaume S, Soler S, Issartel B, Isch JF, Lacassin F, Rougier Y, Tabaste JL. [Peritoneal tuberculosis simulating advanced ovarian carcinoma: a case report]. ACTA ACUST UNITED AC 2003; 31:624-6. [PMID: 14563607 DOI: 10.1016/s1297-9589(03)00179-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Disseminated peritoneal tuberculosis accounts for 1-3% of tuberculosis disease, represented by high frequency of lung defects in endemic countries. The authors report one case in a 43-year-old woman, the initial interpretation of which, based on pleural and peritoneal exudate, showed suspected latero-uterine mass and significant elevated serum CA 125 level, mimicking disseminated ovarian carcinoma. Only after exploring laparotomy with biopsy was disseminated peritoneal tuberculosis identified, thus correcting the diagnosis. Symptomatology, X-ray defect, and cynetic of serum CA 125 level were left in totality after 3 months of antituberculosis multidrugs. This is a diagnostic trap, which presents a new interest for such pathology as tuberculosis, which is on the increase again in the West.
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Affiliation(s)
- S Lantheaume
- Service de gynécologie-obstétrique, CHT Magenta, 7, avenue Paul-Doumer, BP J5, 98800 Nouméa, Nouvelle-Calédonie.
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Piura B, Rabinovich A, Leron E, Yanai-Inbar I, Mazor M. Peritoneal tuberculosis--an uncommon disease that may deceive the gynecologist. Eur J Obstet Gynecol Reprod Biol 2003; 110:230-4. [PMID: 12969590 DOI: 10.1016/s0301-2115(03)00101-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To document women with peritoneal tuberculosis mimicking ovarian malignancy and to review pertinent literature. STUDY DESIGN The records of women with peritoneal tuberculosis who were managed at the Soroka Medical Center, Beer-Sheva, Israel between January 2000 and December 2001 were reviewed. RESULTS Four patients with peritoneal tuberculosis mimicking ovarian malignancy were encountered. Two presented with the classical symptomatology of advanced-stage ovarian carcinoma including ascites, abdominopelvic masses and elevated serum CA-125, and two presented with lower abdominal pain and adnexal mass. Laparoscopy in one patient and laparotomy in three patients revealed peritoneal tuberculosis and no malignancy. Of the three patients who had laparotomy, two underwent unnecessary extended surgery including total hysterectomy, bilateral salpingo-oophorectomy, omentectomy and bilateral pelvic lymphadenectomy, and one had conservative surgery including unilateral salpingo-oophorectomy. All patients were postoperatively treated with quadruple anti-tuberculosis chemotherapy. CONCLUSIONS Medical awareness of peritoneal tuberculosis is still lacking and many women with this disease are initially thought to have ovarian malignancy and undergo unnecessary extended surgery. Laparoscopy including biopsies seems to be a sufficient and safe method to provide diagnosis of peritoneal tuberculosis. If laparoscopy is not feasible, laparotomy should be performed. If no malignancy is detected and the diagnosis of peritoneal tuberculosis is confirmed, unnecessary extended surgery is avoided and anti-tuberculosis treatment is started.
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Affiliation(s)
- Benjamin Piura
- Unit of Gynecologic Oncology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer-Sheva, Israel.
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Miralles C, Orea M, España P, Provencio M, Sánchez A, Cantos B, Cubedo R, Carcereny E, Bonilla F, Gea T. Cancer antigen 125 associated with multiple benign and malignant pathologies. Ann Surg Oncol 2003; 10:150-4. [PMID: 12620910 DOI: 10.1245/aso.2003.05.015] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cancer antigen (CA) 125 tumor-associated antigen is a high molecular glycoprotein used for follow-up of epithelial ovarian cancer. The test is often requested as a differential diagnosis in patients with pleural or peritoneal fluid. This study analyzes the prevalence of CA-125 increases in a population of patients attending a general hospital and discusses the possible clinical implications of increased levels. METHODS On 4 different days, 380 CA-125 assays were performed in randomly selected patients attending our hospital. Serum CA-125 was measured with a commercial enzyme immunoassay, and clinical records were reviewed for assessment of clinical parameters. RESULTS Sixty-one patients (16%) had increased CA-125. The pathologies of these patients were heart failure in 9 (14.7%), lung disease 11 (18%), hepatic cirrhosis in 7 (11.4%), malignant tumors in 9 (14.7%), intra-abdominal nonhepatic disease in 6 (10%), previous surgery in 17 (27.8%), and miscellaneous in 2 (3%). Effusions were seen in 34 patients (55.7%). CONCLUSIONS Our data confirm the variety of benign and malignant pathologies coursing with increased CA-125. Cardiovascular and chronic liver disease were the most frequent diagnoses in patients with increased CA-125; this supports the opinion that CA-125 lacks utility as a marker for malignancy. CA-125 could have a role in the follow-up of cardiovascular, hepatic, and tumoral diseases with serosal involvement.
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Affiliation(s)
- C Miralles
- Servicio de Oncología, Clínica Puerta de Hierro, Hospital Universitario, Madrid, Spain
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