Pelvic tuberculosis in a postmenopausal woman mimicking ovarian malignancy--a clinical dilemma.

A 72-year-old postmenopausal woman presented with dyspepsia, weight loss, abdominal pain, and ascites. Ultrasonography revealed a pelvic mass and evidence of pyometra. Serum CA-125 was raised. Paracentesis revealed lymphocytic exudate but no malignant cells or acid-fast bacilli. However, after drainage of pyometra endometrial curettings revealed epithelioid granuloma with acid-fast bacilli. She had complete recovery with full course of antituberculosis treatment. Thus, pelvic tuberculosis should be considered in the differential diagnosis of ovarian malignancy, which can prevent many unnecessary laparotomies.