Tuberculous Peritonitis Diagnosed by GeneXpert in Ascitic Fluid Despite Markedly Elevated Carcinoembryonic Antigen: A Case Report from Timor Leste

Background: Tuberculous peritonitis is an uncommon form of extrapulmonary tuberculosis that can closely mimic intra-abdominal malignancy because of its nonspecific clinical presentation, ascites, weight loss, and elevated tumor markers. In selected patients, GeneXpert MTB/RIF testing of ascitic fluid may provide a rapid means of confirming Mycobacterium tuberculosis infection.
Case Presentation: A 24-year-old Timorese woman was referred from a peripheral health-care facility to Hospital Nacional Guido Valadares (HNGV) with progressive abdominal distension, abdominal pain, anorexia, and significant weight loss. Physical examination revealed gross ascites. Laboratory investigations demonstrated a markedly elevated carcinoembryonic antigen (CEA) level of 109 µg/L, raising significant concern for gastrointestinal or gynecological malignancy. Diagnostic paracentesis revealed exudative ascitic fluid. GeneXpert MTB/RIF testing of the ascitic fluid detected Mycobacterium tuberculosis with no evidence of rifampicin resistance. Cytological examination showed no malignant cells. Abdominal imaging demonstrated significant ascites but no definite intra-abdominal mass or other convincing evidence of malignancy. Based on the clinical presentation and molecular detection of M. tuberculosis, the patient was diagnosed with tuberculous peritonitis and commenced on standard anti-tuberculosis therapy. She subsequently demonstrated clinical improvement.
Conclusion: Tuberculous peritonitis should remain an important differential diagnosis in young adults presenting with ascites, weight loss, and abdominal symptoms in tuberculosis-endemic settings such as Timor-Leste, even when tumor markers such as CEA are markedly elevated. This case demonstrates that elevated CEA does not necessarily indicate malignancy and that GeneXpert MTB/RIF testing of ascitic fluid can contribute to rapid diagnosis in appropriate clinical settings. Early recognition of abdominal tuberculosis may prevent unnecessary invasive investigations or surgical intervention and facilitate timely initiation of effective treatment.

Tuberculous peritonitis, Ascites, GeneXpert, Carcinoembryonic antigen, Extrapulmonary tuberculosis, Timor-Leste

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