Elevated CA-125 in disseminated tuberculosis: a case report

CA-125 is an epithelial marker derived from coelomic epithelium. It is elevated in 90% of advanced ovarian cancers and has a sensitivity of 57–80% and specificity of 100%. Therefore, CA-125 is an important investigation in evaluating a pelvic mass. However, any process that disrupts the epithelial lining of the peritoneum has the potential to raise its level. Therefore, it can be elevated in many non-neoplastic conditions such as hepatitis, pancreatitis, menstruation etc.1 We illustrate a patient who presented with elevated CA-125 levels but was ultimately diagnosed as having disseminated tuberculosis. A 25-year-old unmarried girl came with 6 months history of lower abdominal pain, dysmenorrhea and vomiting. Her ultrasound of the abdomen showed a tubo-ovarian mass. Her CA-125 level was 1295 U/ml (normal value < 35 U/ml). HIV, monteux and quantiferon tuberculosis (TB) Gold test were negative. Chest X-ray showed left pleural effusion and analysis of the pleural fluid showed a protein of 5.4 g% and 185 cells with lymphocytic predominance. Pleural fluid analysis for malignant cells was negative. In view of the clinical presentation and raised CA-125 levels, a possibility of ovarian malignancy with pulmonary extension was considered and an exploratory laparotomy was planned. However, 2 days prior to surgery she developed headache followed by left focal seizures with secondary generalization.