ELEVATED CA125 SERUM LEVELS IN A PATIENT WITH TUBERCULOUS PERITONITIS

A 59-year-old Japanese woman, gravida 4, para 2, was referred to hospital because of elevated serum CA125 levels. She had had the menopause at the age of 47, and she denied any constitutional symptoms. In December, 1989, she presented at the Gynecology Service complaining of lower abdominal discomfort. Pelvic examination was negative. Computed tomography of the chest, abdomen, and pelvis was normal, except for a small amount of ascites in the cul-de-sac. A chest X-ray and ultrasonogram were negative on admission. The serum CA125 level was 390. The haemoglobin and white blood cell count were normal. The serum CA125 rose to 1,400 in January, 1990, and the patient underwent a laparoscopy. There were approximately 200 ml of ascites. The left fallopian tube was found to be slightly adherent to the left ovary, whose outer surface seemed rough. Multiple biopsies were obtained for microscopic examination. The uterus and right adnexae were of normal appearance. Microscopy showed tuberculous peritonitis (Fig. 1). Multiple endothelial granulomas were found on the peritoneal surface of the left ovary and Langhans' giant cells and lymphocyte infiltration were seen. Ziel-Neelsen stain was positive for acid-fast bacilli. A tuberculin test gave an area of induration, 2.0 cm in diameter, in 48 h. The patient was given isoniazid (0.4 g/day), rifampicin (0.45 g/day), and ethambutol (1.0 g/day) for a 3-month period. Following this, the patient appeared to lose her ascites and the serum CA125 level fell to the normal range by the end of February.