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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.1352
Primary peritoneal sarcoidosis – A rare and challenging diagnosis
Part of Topic
Benign Gynaecology
Primary peritoneal sarcoidosis – A rare and challenging diagnosis
V.J. Meegoda1, K.G. Hewawitharana1, K.V.H. Nimana1, M A A M Jayawardane1, 2
1University professorial unit of Obstetrics & Gynecology, Colombo South Teaching Hospital., Colombo, Sri Lanka
2Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
INTRODUCTION
•Sarcoidosis is a rare multisystemic inflammatory disorder that has a predilection toward lungs and lymph nodes.
•Diagnosis is challenging and depends on demonstrating non-caseating epithelioid granulomas with the exclusion of common granulomatous diseases.
CASE PRESENTATION
•A 57-year-old postmenopausal female, while being evaluated for a cystocele, incidentally found to have ascites on USS along with elevated CA-125 levels.
•CECT didn’t demonstrate adnexal masses nor enlarged lymph nodes.
•Although Mantoux was positive, HRCT-chest didn’t demonstrate evidence TB or other lung pathology and sputum PCR for TB and culture was negative, thus leaving us at a diagnostic dilemma.
•An exploratory laparotomy was undertaken where multiple whitish tubercle-like lesions were found consistent with peritoneal tuberculosis and significant adhesions.
•Histo-pathological evaluation revealed multiple epithelioid cell granulomata, leaving us with the possibility of tuberculosis or sarcoidosis and excluding the diagnosis of peritoneal carcinomatosis.
•Given that TB is common in Sri Lanka, while being investigated the patient was started on the anti-TB regimen for peritoneal tuberculosis.
However, ESR and CA-125 continued to rise after weeks of therapy, and a diagnosis of peritoneal sarcoidosis was made. She responded well to corticosteroids, thus confirming the diagnosis
DISCUSSION
•Extrapulmonary involvement in sarcoidosis is considered rare, and primary peritoneal sarcoidosis is extremely uncommon with only a handful of reported cases.
•Given that TB is widely prevalent, an initial diagnosis of TB-peritonitis or widespread carcinomatosis, as suggested by elevated CA-125 and ascites, is justifiable, but sarcoidosis is a disease entity that should not be overlooked.
•Elevated ACE levels (sensitivity – 41.4%, specificity – 89.9%) are indicative of sarcoidosis.
CONCLUSIONS
•Peritoneal sarcoidosis should be considered as a differential diagnosis specially when histology demonstrates non-caseating epithelioid granulomas.