Abdominopelvic tuberculosis in a nonsexually active young woman

An 18-year old female presented with fever to 40.5°C, chills, diffuse persistent abdominal pain, appetite loss, diarrhea, dyspnea, and precordial pain. Her menstrual cycles were irregular. She reported no previous sexual activity and had no previous medical problems, but her parents and an aunt had been diagnosed with pulmonary tuberculosis (TB). She had a body mass index of 20.09 kg/m2 and reported a weight loss of 4 kg over a period of 2 months. Laboratory evaluation demonstrated an inflammatory syndrome, with erythrocyte sedimentation rate of 49 mm per hour, C-reactive protein of 20 mg/dL, fibrinogen 496 mg/dL, ferritin 759 ng/mL, and procalcitonin 2.6 ng/mL. Cancer antigen 125 (CA125) was increased to 214.9 U/mL, although carcinoembryonic antigen and alpha-fetoprotein were negative. Pelvic magnetic resonance imaging revealed bilateral tubo-ovarian abscesses, inflammatory lymphadenopathy, and ascitic fluid between the ileal loops (Figure 1).