Hidden in plain sight: omental tuberculosis disguised as ovarian cancer: a case report

Abstract

We present the case of a 39-year-old woman with no significant past medical history who developed a six-month history of bilateral lower limb pain, progressive weakness, weight loss, abdominal distension, and intermittent fever. Clinical examination revealed pallor, hepatomegaly, right-sided pleural effusion, and a firm pelvic mass. Radiological evaluation suggested peritoneal carcinomatosis with possible skeletal metastases; however, pleural fluid cytology was negative for malignant cells. Histopathological analysis of an omental biopsy revealed epithelioid granulomas with caseous necrosis, and Ziehl–Neelsen staining confirmed acid-fast bacilli, establishing the diagnosis of disseminated tuberculosis. The patient showed significant improvement with antitubercular therapy. This case points out the requirement of considering tuberculosis in presentations that mimic malignancy, particularly in high prevalence countries.