Challenging Case of Abdom...

A 25-year-old woman presented with worsening abdominal pain and distension over two months, along with a 17 kg weight loss five months prior. She had no history of chronic illness, tuberculosis, or family history of malignancy, though previous ultrasound scans suggested possible ovarian malignancy. Examination revealed stable vital signs, moderate ascites, and anemia with a hemoglobin level of 8.1 g/dL. Her CA-125 level was significantly elevated at 792.1 U/mL. Abdominal paracentesis revealed serous fluid with a lymphocyte count of 300 cells/mm³, no malignant cells, and a negative gene Xpert test for tuberculosis. However, the serum ascites albumin gradient was 0.98 g/dL, ADA was elevated at 54.6 IU/L, and the IGRA test was positive. A CT scan was conducted for further evaluation.