Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

O&G Forum 2019; 29: 31 - 32 CASE REPORT Female Genital Tract Tuberculosis: A Case Report Abstract Background: Genital tuberculosis is responsible for infertility in many women. This is especially seen in developing countries where early diagnosis of female genital tract tuberculosis (TB) is often challenging. Case: We present a case of a 28 year old, nulliparous woman with secondary amenorrhea and infertility. She had a negative progesterone withdrawal challenge. In addition, she had intra-uterine adhesions and the biopsy showed extensive granulomatous inflammation with central micro-abscess formation. The acid fast bacilli test was negative however the diagnosis of genital TB was still applicable in view of the presence of granulomatous lesions in the background of HIV sero-positivity. Conclusion: The patient was managed as a case of genital TB and commenced with TB treatment. Following five months of TB therapy, she began menstruation again. Keywords: Mycobacterium tuberculosis, Female genital tract tuberculosis, Myomectomy, Amenorrhea, Infertility Correspondence Dr M. Mchunu email: kayamchunu@gmail.com M. Mchunu 1 , D. Seevnarain 1 , K. Naicker 1 , M. Morapedi 1 , N. Memo 1 , H.M. Sebitloane 1 1 Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Introduction Tuberculosis (TB) is one of the leading causes of morbidity and mortality in South Africa (SA). 1 The underlying bacterium respon- sible for infection is Mycobacterium tuberculosis (MTB) which can be transmitted via an infected person’s cough and sneeze. 2 There are several risk factors which lower immunity resulting in susceptibility to secondary infections such as TB. Co-infection with HIV as well as the emergence of multidrug resistant (MDR) and extreme-drug resistant (XDR) TB strains is a growing concern. Extra pulmonary TB can affect bones, joints, meninges, urinary and gastro-intestinal tract. 3,4 Genital TB (GTB) is the most common secondary to spread from pulmonary TB via haematogenous and lymphatic route. 4 Many women are affected by genital TB. The incidence of female genital tract tuberculosis (FGTB) in SA is between 6-21%. 4 FGTB is more commonly seen in younger women (20-40 years). The fallopian tubes, endometrium, ovaries and cervix are involved in most cases ranging from 90-100%; 50-80%; 20-30% and 5-15% respectively. 3,4 Rarely, TB of the vagina and vulva is seen (1-2%). 3,4 Approximately 11% of women with GTB are asymptomatic how- ever the most common presentation is infertility, 4 which accounts for 26% of infertility, where tubal involvement can be as high as 48.5%. 4 However, the symptoms depend on the genital site affect- ed. 4 These include menstrual disturbances: especially oligomenor- rhoea or amenorrhoea, vaginal discharge and chronic pelvic pain. 4 The abdomen feels doughy, and there may be presence of ascites and masses. 4 The diagnosis of FGTB is difficult due to the various clinical presentations. However, there are various methods for diag- nosis which include blood tests, ultrasound, hysterosalpingography, hysteroscopy, laparoscopy, CT, MRI, histopathology, endometrial biopsy, detection of MTB (microscopy/culture) and PCR. 4 Patient history also provides vital information for suspected cases of FGTB which includes previous exposure/treatment of TB, HIV, lymphade- nopathy and other sites of TB infection. 4 The World Health Organization (WHO) recommends that extra pulmonary TB treatment should include two months of rifampi- cin, isoniazid, pyrazinamide and ethambutol followed by four-sev- en months of rifampicin and isoniazid. 4,5 Surgery can also be per- formed in a woman if tubo-ovarian abscess is present or pyosalpinx. Women with GTB have tubal damage but if the endometrium is healthy, in vitro fertilization will increase rate of conception reduc- ing infertility. However, if FGTB is left untreated, it can result in permanent sterility. We present a case on a patient with secondary OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 31