Female genital tuberculosis mimicking advanced ovarian cancer - a diagnostic dilemma in resource limiting setup: case repot and literature review.

Introduction and importance: Tuberculosis (TB), a major global health issue, predominantly affects the lungs but can manifest as extrapulmonary TB, including rare genitourinary TB. Isolated genital TB is uncommon, making diagnosis challenging and requiring careful evaluation to differentiate it from tumors, especially in low-resource settings. Case presentation: A 20-year-old nulliparous Ethiopian woman presented with a history of long-standing abdominal swelling and constitutional symptoms, including fever and significant ascites. Investigations revealed bilateral adnexal masses and lymphocyte-predominant ascitic fluid, negative for malignant cells. Initially, advanced ovarian tumor was the primary differential diagnosis, leading to consideration for exploratory laparotomy. However, due to the patient's unfitness for surgery, tubo-ovarian tuberculosis was considered following further evaluation. The patient demonstrated improvement after initiating anti-tuberculosis therapy. Case discussion: TB remains a major global health issue. Genitourinary TB is a common extrapulmonary manifestation, but isolated genital TB is challenging to diagnose due to non-specific symptoms mimicking ovarian tumors. Diagnosis requires confirming mycobacteria via tests like GeneXpert, and while cancer antigen 125 can be elevated, it is not specific. Treatment is a standard anti-TB regimen, with most patients improving without surgery. Conclusion: Ovarian tuberculosis, often mistaken for ovarian tumors, requires thorough evaluation in young patients, especially those from low-resource settings, to avoid unnecessary surgery and prevent complications like infertility.