Ultrasonography and Biomarkers in the Diagnostic Evaluation of Peritoneal Tuberculosis: A Case Series Analysis

Objectives: This study aims to describe the ultrasound findings and biomarker profiles (CA-125, HE4, CEA, ADA, and IGRA) in confirmed cases of peritoneal tuberculosis (PTB) and to discuss their relevance in clinical evaluation. Methods: This is a retrospective study utilizing data from 12 female subjects with a confirmed PTB diagnosis at Cipto Mangunkusumo Hospital and Hermina Depok Hospital between 2018 and 2023. Data were extracted from medical records. Biomarker levels were measured using standardized assays in a single accredited laboratory. Ultrasonography was performed using the Mindray Resona 7 system. Results: The mean age was 33.0 ± 9.7 years. Ultrasonography identified significant features of PTB, such as hydrosalpinx 7 (58.3%), adhesions 6 (50%), ascites 7 (58.3%), cystic/mass-like lesions 4 (33.3%), and involvement of the rectosigmoid colon and small bowel 2 (16.6%). CA-125 levels were elevated (mean: 484.25 U/mL), and HE4 was high in 41.6% of cases (mean: 66.8 pmol/L). CEA levels remained low (mean: 1.725 ng/mL), and ADA levels were elevated in all patients (mean: 45.8 U/L). IGRA testing yielded a 75% positivity rate, with one patient converting from negative to positive after a month. Conclusions: Ultrasound remains a valuable imaging modality for identifying characteristic features of PTB, particularly hydrosalpinx and ascites. Elevated CA-125 and ADA, alongside IGRA results, may support clinical suspicion and help guide diagnosis in settings where invasive procedures are limited.