Tuberculous Peritonitis with High Level of CA19-9 in Serum and Ascitic Fluid: A Case Report with a Brief Literature Review

Jun Teruya, Shigeru Deguchi, Yoshitaka Takeshima, Atsushi Nakachi and Yoshihiro Muto^*

The Division of Surgery, Ginowan Memorial Hospital

^*The First Department of Surgery, Faculty of Medicine, University of the Ryukyus

A case of tuberculous peritonitis in a 43-year-old psychiatric patient with a high level of CA19-9 in serum and ascitic fluid is reported. The patient was referred to our hospital for further examination. On admission, physical examination showed a markedly distended abdomen with diffuse tenderness. Diagnostic imagings including ultrasonography and CT were not contributory to a definitive diagnosis. Subsequently he was tentatively diagnosed with diffuse peritonitis of unknown etiology, and underwent exploratory laparotomy, which revealed macroscopic features of tuberculous peritonotis mimicking peritonitis carcinomatosa. Unexpectedly, his serum and ascitic fluid showed elevated levels of CA125 and CA19-9. Histologically, the tissues of the omentum showed multiple caseous granulomas, indicating tuberculosis, but mycobacterium tuberculosis was not demonstrated on culture and PCR. Following laparotomy, he was treated with tuberculostatic agents: Isoniazid (INH), Ethambutol HCL (EB) and Rifampicin (RFP). Six weeks later he recovered from his peritonitis. Also, CA19-9 returned to the normal range in accordance with the improvement of clinical manifestations of peritonitis.

Key words
tuberculous peritonitis, CA125, CA19-9

Reprint requests
Jun Teruya Department of Surgery, Ginowan Memorial Hospital 3-3-13 Ginowan, Ginowan, 901-2211 JAPAN

Accepted
September 22, 1999

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