case_images: PMC11807723_01
case_images: Transvaginal ultrasound evaluation before treatment.  (A) Uterus with a thin and regular endometrium, with apparently loculated anechogenic fluid, with thickened walls, in the pouch of Douglas. (B) Left adnexal area, with anechoic multiloculated cystic lesions, with hydrosalpinx, ascites and thickening of the peritoneum. (C) Right adnexal area, with an apparently normal ovary, is visualized.
case_images: cureus-0017-00000077250-i01.jpg
case_images: PMC11807723_01_cureus-0017-00000077250-i01.jpg
case_images: FIG1
case_images: Histological examination indicating granulomatous peritonitis. (A) The histological section is occupied by chronic histiocytic inflammatory tissue with granulomatous architecture. (B) Granulomatous inflammation with necrosis. (C) Multiple granulomas. (D) The tissue tested did not express cytokeratins detectable by the AE1/AE3 antibody cocktail.
case_images: cureus-0017-00000077250-i02.jpg
case_images: PMC11807723_01_cureus-0017-00000077250-i02.jpg
case_images: FIG2
case_images: Finally, peritoneal biopsy was negative for malignancy, as the cytology of the ascitic fluid was, but it revealed granulomatous peritonitis (Figure 2) with a positive culture (phenotypic test) for MTBC.
case_images: Transvaginal ultrasound revaluation one year after treatment with antituberculous drugs. (A) Uterus with a thin and regular endometrium, and a thin layer of free fluid in the pouch of Douglas. (B) Right adnexal area with a normal ovary and mild hydrosalpinx. (C) Left adnexal area, with the left ovary and without the anechoic multiloculated cystic lesions previously described.
case_images: cureus-0017-00000077250-i03.jpg
case_images: PMC11807723_01_cureus-0017-00000077250-i03.jpg
case_images: FIG3
case_images: By the end of the treatment, the patient had no symptoms and a near-complete regression of imaging abnormalities was observed (Figure 3), with a normalized CA125 level of 6.3 U/mL.