Ovarian Tuberculosis Mimicking Ovarian Malignancy: A Diagnostic Challenge in an Endemic Setting

Ovarian tuberculosis is a rare manifestation of extrapulmonary tuberculosis and may closely resemble advanced ovarian carcinoma due to overlapping clinical, biochemical, and radiological features. We report the case of an 18-year-old female who presented with progressive abdominal distension, severe hypogastric pain, and unintentional weight loss. Imaging revealed a left adnexal mass with ascites and retroperitoneal lymphadenopathy suggestive of stage IIIC ovarian carcinoma. Serum CA-125 was markedly elevated (637.4 U/mL). Prior to initiation of chemotherapy, an image-guided TRUCUT biopsy demonstrated chronic granulomatous inflammation with acid-fast bacilli. Ziehl-Neelsen staining was positive, QuantiFERON-TB Gold assay was positive, and culture of the adnexal lesion confirmed Mycobacterium tuberculosis. The patient was treated with first-line anti-tuberculous therapy and showed clinical and radiological improvement. This case highlights the importance of considering tuberculosis in the differential diagnosis of adnexal masses with elevated CA-125, particularly in endemic regions, and emphasizes the value of histopathological confirmation to prevent misdiagnosis and avoid unnecessary oncologic treatment.