Tuberculosis being a common disease entity in the Indian subcontinent; a possibility of peritoneal tuberculosis should always be considered as a differential diagnosis in a suspected ovarian malignancy especially with markedly elevated serum CA-125 levels. We present a case of postmenopausal female with abdominal pain, off and on bleeding per vaginum and ovarian mass with high serum CA 125 levels. Exploratory laparotomy revealed extensive adhesions in peritoneum, intestines, uterus and ovaries. Cytology of the peritoneal fluid revealed epithelioid granulomas along with AFB positivity. The presenting signs and symptoms, imaging findings and an elevated CA-125 status in a case of peritoneal tuberculosis may resemble an ovarian malignancy. Proper cytological examination of the Peritoneal fluid sediment along with Pap and simple special stains like Ziehl Neelsen can identify the pathology in such cases and can avoid unnecessary major surgical procedures and special therapies.
