In this case with diffuse nodular peritoneal thickening and enhancement, and bilateral ovarian complex cystic lesions; The initial impression was carcinomatosis. However multiple signs were suggestive of tuberculous peritonitis including the following:

• the young age of the patient and living in an endemic area of TB
• the vaginal purulent discharge
• CBC analysis which revealed explainable anemia
• radiological findings including enlarged necrotic right iliac mesenteric lymph nodes, mural thickening of the terminal ileum, splenomegaly, and the complex ovarian cystic lesions with enhancing defective walls

Ascites aspirate, surgical peritoneal biopsy and culture-confirmed tuberculosis (TB) resulting in tubo-ovarian abscesses (TOA).

Tuberculous peritonitis is misdiagnosed with peritoneal carcinomatosis and is an important differential diagnosis to keep in mind. Fluid aspiration, biopsy and culture are recommended to differentiate between those possibilities.