A 33 year-old woman complaining abdominal pain, ascites, fever and an irregular shape of the left ovarium at CT was admitted to our Department with suspected ovarian malignancy. Ascites fluid examination was negative for tuberculousis. A diagnostic laparoscopy was performed showing a multiple miliary nodules over peritoneum and small bowel loops. Both ovaries were normal. A biopsy showed a tipical caseating granulomas. Nonspecific clinical features of tuberculous peritonitis in females frequently contribute to misdiagnosis and to delay treatment. Suspecting a tuberculous ascites a direct visualization of the peritoneum with peritoneal biopsy is probably the most appropriate and rapid diagnostic tool. Reviewing the literature laparoscopy seems to be the safest and effective method to obtain an early and reliable diagnosis.
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