Is CA 125 raised in Genito urinary TB
Reading File
Searching PubMed
CA-125 tuberculosis genitourinary
Finding Sources
Reading Article
PMID: 28808611
Reading Article
PMID: 25972350
Yes, CA-125 is raised in genitourinary tuberculosis. Here is a detailed breakdown:
CA-125 Elevation in Genitourinary TB
The Short Answer
CA-125 (Cancer Antigen 125) is a well-documented non-malignant cause of elevated CA-125. Genitourinary TB - particularly female genital TB (FGTB) involving the fallopian tubes, uterus, ovaries, and peritoneum - can cause dramatically elevated CA-125 levels, often high enough to mimic advanced ovarian cancer.
Why CA-125 is Raised in TB
CA-125 is produced by mesothelial cells lining the peritoneum, pleura, and pericardium. In TB:
- Peritoneal TB / serosal inflammation - granulomatous inflammation of the peritoneum directly stimulates mesothelial cell CA-125 secretion
- Female genital tract involvement - the fallopian tubes and endometrium are the most common sites of FGTB; inflammation here contributes to elevated levels
- Ascites - TB-related peritoneal exudate further amplifies CA-125 release
- Pleural TB - if coexisting, adds to the total CA-125 burden
Clinical Significance
This is a classic diagnostic pitfall: a woman (often premenopausal, from a TB-endemic region) presents with:
- Pelvic/abdominal mass
- Ascites
- Elevated CA-125 (sometimes >1000 U/mL)
- Weight loss, fever
...and is wrongly diagnosed with advanced ovarian cancer, sometimes undergoing unnecessary surgery or chemotherapy before TB is confirmed.
A 2017 case report and literature review (PMID 28808611) from Hawaii documented exactly this scenario - pelvic TB involving the peritoneum, uterus, and ovaries with markedly elevated CA-125, initially thought to be ovarian cancer until laparotomy revealed TB. The authors specifically emphasized including TB in the differential for any patient with an abdominopelvic mass and elevated CA-125.
A letter in QJM (PMID 25972350) specifically addressed the link between genitourinary TB, CA-125 elevation, and tuberculin anergy in disseminated disease.
Key Points for Exams / Clinical Practice
| Feature | Detail |
|---|---|
| Marker elevated? | Yes - CA-125 can be markedly elevated |
| Mechanism | Mesothelial cell stimulation by peritoneal/serosal granulomatous inflammation |
| Level | Can be very high (>500-1000 U/mL), not just mildly elevated |
| Clinical trap | Mimics ovarian cancer - leading to unnecessary surgery or chemo |
| Clue to TB over cancer | Young age, fever, lymphocytosis, no solid mass on imaging, from TB-endemic region |
| Confirmatory tests | Endometrial biopsy, laparoscopy with biopsy (histology showing caseating granulomas), AFB culture, NAAT/PCR for TB |
| CA-125 after treatment | Levels fall with successful anti-TB therapy |
Other Non-Malignant Causes of Raised CA-125 (for context)
- Endometriosis
- Pelvic inflammatory disease
- Liver cirrhosis / ascites
- Pleural effusion (any cause)
- Peritoneal dialysis
- Pregnancy (first trimester)
- Menstruation
- Peritoneal / genitourinary TB (as above)
So to directly answer: Yes, CA-125 is raised in genitourinary TB, and it can be significantly elevated - a fact that is clinically important because it creates a dangerous mimicry of ovarian malignancy.
This is a shared conversation. Sign in to Orris to start your own chat.