European Journal of Obstetrics & Gynecology and Reproductive Biology
Case reportPeritoneal tuberculosis—an uncommon disease that may deceive the gynecologist
Introduction
Peritoneal tuberculosis is uncommon in the western world, although an increase of this disease has been noted in immigrants from countries with a high prevalence of tuberculosis and in AIDS patients [1], [2], [3], [4]. Since the clinical manifestations of peritoneal tuberculosis may resemble those of ovarian carcinoma with ascites, abdominopelvic masses and elevated CA-125, many women with this disease in the western world are first seen by a gynecologist [1], [2], [3], [5], [6], [7], [8], [9], [10]. The gynecologist who is not aware of peritoneal tuberculosis is deceived by the clinical presentation and even sometimes by the intra-operative findings of this disease. Consequently, patients with peritoneal tuberculosis are misdiagnosed as having ovarian malignancy and are subjected to unnecessary extended surgery. Israel has been a country of new immigrants from many countries in the world and in recent years especially from the former Soviet Union. This report includes four patients with peritoneal tuberculosis who were managed at the Soroka Medical Center, Beer-Sheva, Israel over the last 2 years; one of these patients (Case 1) has previously been reported elsewhere [11].
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Patients and methods
The clinical and pathological 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. The diagnosis of tuberculosis was based on the following histopathologic criteria and laboratory tests. Histopathologic criteria: (1) the presence of a proliferative granulomatous lesion with central caseation necrosis surrounded by concentric layers of epithelial and giant cells with peripheral
Results
Four women with peritoneal tuberculosis were encountered. The clinical and pathological details, treatment and outcome of the patients are summarized in Table 1. All patients were Jewish; two were of Eastern European origin (Ashkenazi) (Cases 2 and 3) and two were of Asian–African origin (Sephardic) (Cases 1 and 4). Three were immigrants; two (Cases 2 and 3) from the former Soviet Union and one (Case 1) from India. Time in Israel ranged from 3 months to 10 years. One patient (Case 4) was born
Discussion
Although the rate of tuberculosis in the western world has in recent years increased due to increased immigration from endemic countries for tuberculosis and with the increase in HIV infection and the number of immunocompromised patients, medical awareness of peritoneal tuberculosis in western societies is still lacking [1], [2], [3]. Three (Cases 1, 2 and 3) of the four patients were immigrants from countries known to have a high prevalence of tuberculosis (India, Moldavia and Ukraine,
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