W e read with interest the article published in Cancer earlier this year regarding the elevation of CA 125 in patients with non-Hodgkin's lymphoma and its normalization with clinical response. 1 Earlier a case report had also emerged about elevation of CA 125 in a patient within tuberculous peritonitis. 2 We would like to add that we have seen and treated a patient with pulmonary tuberculosis who had a high CA 125 at presentation which normalized with successful treatment. A woman age 65 years was brought to the oncology clinic with a 4-month history of generalized body weakness, cough, and weight loss. She looked cachectic and emaciated. On examination, she appeared wasted and crepitations were heard in the left middle zone of the lung. Abdominal examination revealed wasting of abdominal muscles and an otherwise normal examination. She also brought with her a report of CA 125, which revealed a value of 256 IU/mL (normal, ฯฝ35 IU/mL). The patient's daughter works as a technician in our chemical pathology laboratory and had earlier lost her father to squamous cell carcinoma of the lung. She had her mother's CA 125 checked out of her own curiosity, and its elevation, was the reason for the oncology consultation. A chest X-ray revealed bilateral patchy infiltration and cavitation in left mid-lung zone. There was a minimal pleural effusion. The sputum smear showed acidfact bacilli. The patient began to receive a four-drug antituberculosis regimen consisting of isoniazid, rifampin, ethambutol, and pyrazinamide. Three months later, the patient had marked symptomatic improvement, the sputum examination had become negative, and serum CA 125 had decreased to 56.8 IU/mL. After 9 months of treatment for pulmonary tuberculosis, the CA 125 is 16.8 IU/mL. The chest X-ray still shows cavitation along with fibrosis; however, the sputum is negative for acid-fact bacilli.
To our knowledge, this is the first report of elevation of CA 125 in a patient with pulmonary tuberculosis and its normalization with treatment. It has been suggested that CA 125 is produced by mesothelial cells, and in this case it may have represented some kind of response of pleural mesothelial cells to tuberculosis. 3 The role of CA 125 may need to be explored further for it to be used as a routine marker for monitoring response of pulmonary tuberculosis to treatment.