CRA45 TUBERCULOSIS MIMICKER

LF Tan1, UN Daut2 , T Abdul Aziz2
1 University Putra Malaysia, Serdang, Selangor, Malaysia
2 Hospital Sultan Abdul Aziz Shah, Serdang, Selangor, Malaysia

Introduction: 

Tuberculosis (TB) is an infectious disease which may affect various organs system and make it a great mimicker. Disseminated tuberculosis describes lymphohematogenous spread of Mycobacterium tuberculosis bacilli involving two or more organ systems. With the multiple systems involvement, malignancy is indeed one of the most significant "chameleons", and vice versa. 

Case report: 

A 46-year-old woman presented with prolonged fever for 2 weeks associated with reduced appetite. Initial blood showed erythrocyte sedimentation rate (ESR) of 99mm/H, Ca-125 735 units /mL. Further investigations revealed left ovary heterogenous mass with gross ascites, thickened omentum and mild to moderate pleural effusion. In computerized tomography (CT) scan, the lesions were described as features of carcinoma left ovary by radiologist. Thus, malignancy was suspected at the first place in this patient. Pleural fluid and peritoneal fluid acid fast bacilli smear, cytology and culture are all negative. However, the histological examination of omental biopsy showed caseating granulomatous serositis. She was started on anti TB and fever settled after medication.

Conclusion:

This case illustrated diagnostic challenge in patient with atypical organ involvement versus tuberculosis. Thorough diagnostic workup is crucial when either TB or malignancy is suspected. Imaging studies, cytology, microbiological tests for TB, and potentially biopsies to rule out or confirm malignancy. It is significant to tackle the correct diagnosis by ruling out differential diagnosis and perform histological examination. Correct diagnosis help in improve patient’s outcome and reduce mortality rate.