Our patient is a 65‐year‐old woman from the Philippines with a medical history significant for rheumatoid arthritis and diabetes mellitus who presented to an outside medical facility with complaints of increased abdominal girth, weight loss, fevers, and night sweats for the past 8 weeks. The patient denied sick contacts but had recently returned from a vacation to Las Vegas and had also recently visited the Philippines. Physical exam revealed diminished breath sounds at the bases and abdominal distention with fluid wave. Pelvic exam was significant for “plaque in the cul‐de‐sac.” CT of the abdomen and pelvis revealed large abdominal ascites, moderate bilateral pleu‐ral effusions, and induration and nodularity of the omentum and mesentery. Pelvic and transvaginal ultrasound was unremarkable save for an inability to visualize the ovaries. Fluid sent from bronchoscopy, thoracentesis, and paracentesis returned negative for malignancy and acid‐fast bacilli (AFB). The patient's liver functions tests were normal, but a CA‐125 was elevated to 445 U/mL (reference value < 35). A preliminary diagnosis of ovarian cancer was settled on, and the patient was transferred to the gynecologic oncology service at our facility for exploratory laparotomy. The surgeons noted “massive amounts of adhesions” and an inability to distinguish large and small bowel loops. A frozen section sent during the procedure returned with granulomatous disease, no hysterectomy or oophorectomy performed, and the patient was transferred to medicine. On consultation with infectious disease, it was decided to presumptively begin treatment for tuberculosis with isoniazid, ethambutol, pyrazinamide, and rifampin. AFB cultures at our institution were negative at the time of discharge. Several months later, AFB smears of the omental biopsy returned positive for tuberculosis.
Tuberculous peritonitis and ovarian cancer share many frightening similarities. The vague symptoms of weight loss, fevers, and abdominal distention from ascites are common in both, as is an elevated CA‐125. Imaging, such as CT scan or ultrasound, is unable to distinguish the 2, with laparotomy with biopsy usually necessary. Tuberculous peritonitis is rare in the Western world, although more common in conjunction with HIV infection. Empiric tuberculosis therapy after granu‐lomatous changes seen on biopsy is usual necessary, as it may take 4–8 weeks for smears to turn positive.
Although the overall incidence of tuberculosis (TB) across the globe is falling, one third of the world's population is infected with Mycobacterium tuberculosis. Half of all new cases of TB are in 6 countries: China, India, Bangladesh, Indonesia, Pakistan, and the Philippines (where our patient was from). With the understanding that 1.77 million people died of TB in 2007, it is important for hospitalists to recognize this deadly disease in all its forms.
S. Greenhalgh ‐ none; E. Wantuch ‐ none; J. Belmares ‐ none
To cite this abstract:Greenhalgh S, Wantuch E, Belmares J. Counterfeit Cancer. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 288. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/counterfeit-cancer/. Accessed May 26, 2019.