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Introduction: Genital and peritoneal  tuberculosis presentation can mimic that of an ovarian tumor by its vague symptoms and non-specific clinical, laboratory and radiological findings leading to misdiagnosis .
Case Report: A woman of 43 years with a history of two previous successful pregnancies and cesarean section presented with pelvic pain, weight loss,mild ascites, and elevated CA-125 and HE4 level .
A diagnosis of highly probable ovarian carcinoma was made, and laparotomy performed with resection of both ovaries and pelvic total lymphadenectomy. Postoperative histopathological examination showed necrotizing granulomatous inflammation,highly suggestive of tuberculosis with no sign of malignancy.
Conclusion: Antituberculosis treatment was commenced, with full resolution of symptoms.
It may not be possible to rule out ovarian malignancy or confirm abdominal tuberculosis and it often does not give a definitive diagnosis without exploratory laparotomy . CA-125 can rise in both conditions, and imaging is rarely conclusive.
Early diagnosis of peritoneal/ovarian tuberculosis is vital as it can lead to infertility. As they often present with advanced pathology beyond recovery because of  delayed diagnosis, antitubercular therapy may not be effective in restoration of women’s fertility function.
Conflict of interest: non declared

Keywords: Tuberculosis Female Genital

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