Pelvic tuberculosis: from millets to masses

An adnexal mass is a common entity in the reproductive age group. Ovarian masses form a majority of this condition. Tuberculosis is a disease commonly encountered in the Tropics and is endemic to India. Abdominopelvic affliction of this disease is common in women especially in the reproductive age groups. It may present with variety of non-specific clinical features and often poses an enormous diagnostic dilemma Author report one such case, presenting with a clinical impression of ovarian malignancy, however, was diagnosed to be a case of extensive pelvic tuberculosis on laparoscopy. Tissue biopsy was consistent with the finding of tuberculosis.

Tuberculosis pélvica y antecedente de embarazo. Reporte de caso / Pelvic tuberculosis and pregnancy antecedent. Case report

Resumen A lo largo del tiempo, la tuberculosis ha sido un problema de salud pública. La Organización Mundial de la Salud reporta anualmente alrededor de 8 millones de casos nuevos y 3 millones de muertes. En México se estima que anualmente prevalecen cerca de 64,000 casos de esta enfermedad gue puede afectar diferentes órganos con presentaciones clínicas gue simulan otras patologías. Se presenta el caso de una paciente de 22 años de edad con antecedente de embarazo normo evolutivo y parto vaginal 4 meses antes sin complicaciones, gue inició su cuadro clínico en el puerperio con presencia de tos en accesos gue remitió un mes posterior acompañado de síndrome de desgaste, pérdida de peso, dolor abdominal difuso, diarrea y fiebre. Recibió múltiples tratamientos sin mejoría, ingresó a nuestro hospita con cuadro de síndrome abdominal agudo y se le realizó laparotomía exploradora con hallazgos de abdomen congelado, engrosamiento de peritoneo parietal, adherencias fijas, colecciones en hueco pélvico, con material purulento caseoso, blanquecino, poco fétido, tejido friable, presencia de granulomas en asas de intestino; se realizó histerectomía subtotal abdominal con ooforectomía bilateral, la evolución posquirúrgica fue lenta hacia la mejoría tras corroborar por reporte histopatológico y cultivo el diagnóstico de tuberculosis pélvica e iniciar tratamiento específico.

Abstract Tuberculosis has been overtime public health problem. The World Health Organization reports annually about 8 million new cases and 3 million deaths. In Mexico, an estimation of around 64,000 prevalent cases of this disease are reported annually. Tuberculosis can affect different organs with clinica presentations that mimic other diseases. A patient presents a history of normal pregnancy and vaginal delivery without complications for 4 months. The clinical picture begins in the postpartum period with the presence of cough accesses registered a month later accompanied by fatigue, weight loss, diffuse abdominal pain, diarrhea and fever syndrome. She received multiple treatments without improvement. She was ad missioned to our hospital and an acute abdomen laparotomy was performed with findings of abdominal frozen thickened parietal peritoneum, fixed adhesions, collections of pelvic cavity with whitish, slightly fetid pus, friable tissue, presence of granulomas in bowel loop. A subtotal abdominal hysterectomy with bilateral oophorectomy was performed. The postoperative evolution showed a slow improvement after the reportand was corroborated bya histopathological diagnosis of pelvic tuberculosis culture and the initiation of a specific treatment.

Analysis on Tn17/Treg cells in patients with pelvic tuberculousis / 临床检验杂志

Objective To investigate the cellular immunologic response of TH 17/Treg cells in the peripheral blood of pelvic tuberculosis patients and explore their roles in the pathogenesis of pelvic tuberculosis.Methods The intracellular flow cytometry was performed to evaluate the expressions of TH 17 and Treg cells in 46 pelvic tuberculosis patients and 25 healthy controls in childbearing age.Twenty-eight of the 46 pelvic tuberculosis patients were followed up to monitor the variation of the TH17/Treg cells after 3 months and 6 months of anti-tuberculosis treatment.Results The percentage of TH 17 cells in the peripheral blood of pelvic tuberculosis patients was (3.26 ± 1.30) ％ which was significantly lower than that of healthy controls [(4.92 ± 1.71) ％,P ＜ 0.01].The percentage of Treg cells in the patients was (5.18 ± 1.53) ％ which was significantly higher than that of healthy controls [(3.26 ± 1.10) ％,P ＜ 0.01].The percentage of TH17 cells in the pelvic tuberculosis patients after 6 months of treatment was (4.67 ± 1.75) ％ which was significantly higher than that in the patients before treatment and after 3 months treatment [(3.26 ± 1.30) ％,P ＜ 0.01 and (3.70 ± 1.06) ％,P ＜0.01,respectively].The percentage of Treg cells in pelvic tuberculosis patient after 6 months of treatment was (3.93 ±0.94)％ which was significantly lower than that in the patients before treatment and after 3 months of treatment [(5.18 ± 1.53)％,P ＜0.01 and (4.94 ± 1.51) ％,P ＜ 0.01,respectively].The percentage of Treg cells in the patients after 6 months of treatment was still significantly higher than that of controls (P ＜ 0.05).The TH 17/Treg ratio before treatment was significantly lower than that of healthy controls (P ＜ 0.01),and the TH 17/Treg ratio was increased after 3 months of treatment but it did not show significant difference compared with that before treatment.The TH 17/Treg ratio after 6 months of treatment (1.18 ± 0.34) ％ was significantly increased in contrast to those after 3 months of treatment and before treatment [(0.77 ± 0.21) ％,P ＜ 0.01 and (0.55 ± 0.13) ％,P ＜ 0.01,respectively].The TH 17/Treg ratio could not rise to the normal level even after 6 months of treatment.Conclusion Both the TH 17 and Treg cells may involve in the immunologic responses of pelvic tuberculosis patients and the imbalance of TH1T/Treg cells may remain persistently.

Pelvic Tuberculosis Mimicking Ovarian Malignancy: A Case Report.

Tuberculosis is a global health problem, primarily seen in developing countries, where there are insufficient health services and high prevalence of human immunodeficiency virus (HIV) has further increased the burden of disease. Pelvic tuberculosis can cause ascites and an abdominal mass that may masquerade as ovarian cancer. CA125 levels are raised in peritoneal tuberculosis. CT scan and MRI also give a similar picture and diagnosis is often difficult. We are presenting an unusual case of pelvic tuberculosis being referred to us as a case of adnexal mass with ascites and raised tumor marker.

Pelvic Tuberculosis continues to be a disease of dilemma - Case series.

Tuberculosis (TB) has become a global epidemic again with emergence of HIV/AIDS and multi-drug resistant strains of TB. Female genital tuberculosis (GT) is typically a disease of young women and its occurrence in post menopausal women is rare. Amongst the genital disorders, GT is the most baffling especially because of its various presentations. So GT is notorious for evading diagnosis. A series of cases of females GT between the age 25 yrs to 40 yrs is being reported with women having spectrum of clinical features, creating diagnostic dilemma and so final diagnosis by histopathology after laparotomy. So a high degree of suspicion aided by intensive investigations may be required for the diagnosis of GT. Medical therapy is the main treatment, however some do need surgery. Research needs to be continued for early establishment of timely diagnosis of GT and modalities of effective therapies.

Outcome of In Vitro Fertilization and Embryo Transfer in Infertile Women with Pelvic Tuberculosis / 대한불임학회지

OBJECTIVES: Pelvic tuberculosis (TB) causes infertility despite of anti-TB chemotherapy and IVF-ET is effective treatment to achieve pregnancy. The aim of this study is to assess the outcomes of IVF-ET in pelvic TB, especially according to main Tb lesion, and to investigate the factors affecting the successful outcome. METHODS: A total of 135 IVF-ET cycles were performed in 54 patients with pelvic TB and the outcome was compared with that of control group with tubal factor not associated with TB in 301 cycles, 227 patients. Anti-TB chemotherapy was performed in the patients with pelvic TB. Pregnancy rate was compared according to main TB lesion as salpingitis, peritonitis, and endometritis. In the patients with endometrial TB, when complicated with uterine synechia, hysteroscopic lysis was done before IVF-ET and pregnancy rate was compared according to the presence of uterine synechia. RESULTS: There was no significant difference in peak E2 (2,790+/-280.1 vs 2,554+/-101.2, p>0.05), the number of retrieved oocytes (13.5+/-0.7 vs 12.5+/-0.4, p>0.05) and fertilized oocytes (7.7+/-0.5 vs 7.8+/-0.3, p>0.05) between patient and control group. Clinical pregnancy rate per transfer in pelvic TB group was 22.9% and showed no difference from that of control group (24.3%, p>0.05). Although it was not statistically significant, pregnancy rate in the endometrial Tb (18%) was lower than that in the salpingitis (28.5%) or peritonitis (26.5%) (p>0.05). In the endometrial TB with uterine synechia, pregnancy rate was significantly lower than that of the patients without synechia even after hysteroscopic lysis (9.7% vs 31.6%, p<0.05). CONCLUSION: IVF-ET after anti-TB chemotherapy is the most effective treatment to achieve pregnancy in infertile patients with pelvic TB. Because the presence of endometrial TB and resulting uterine synechia affects the outcome of IVF-ET, thorough evaluation for endometrium with endometrial biopsy and hysteroscopy is important to predict the prognosis of IVF-ET treatment.

Outcome of In Vitro Fertilization and Embryo Transfer in Infertile Women with Pelvic Tuberculosis / 대한불임학회지

OBJECTIVES: Pelvic tuberculosis (TB) causes infertility despite of anti-TB chemotherapy and IVF-ET is effective treatment to achieve pregnancy. The aim of this study is to assess the outcomes of IVF-ET in pelvic TB, especially according to main Tb lesion, and to investigate the factors affecting the successful outcome. METHODS: A total of 135 IVF-ET cycles were performed in 54 patients with pelvic TB and the outcome was compared with that of control group with tubal factor not associated with TB in 301 cycles, 227 patients. Anti-TB chemotherapy was performed in the patients with pelvic TB. Pregnancy rate was compared according to main TB lesion as salpingitis, peritonitis, and endometritis. In the patients with endometrial TB, when complicated with uterine synechia, hysteroscopic lysis was done before IVF-ET and pregnancy rate was compared according to the presence of uterine synechia. RESULTS: There was no significant difference in peak E2 (2,790+/-280.1 vs 2,554+/-101.2, p>0.05), the number of retrieved oocytes (13.5+/-0.7 vs 12.5+/-0.4, p>0.05) and fertilized oocytes (7.7+/-0.5 vs 7.8+/-0.3, p>0.05) between patient and control group. Clinical pregnancy rate per transfer in pelvic TB group was 22.9% and showed no difference from that of control group (24.3%, p>0.05). Although it was not statistically significant, pregnancy rate in the endometrial Tb (18%) was lower than that in the salpingitis (28.5%) or peritonitis (26.5%) (p>0.05). In the endometrial TB with uterine synechia, pregnancy rate was significantly lower than that of the patients without synechia even after hysteroscopic lysis (9.7% vs 31.6%, p<0.05). CONCLUSION: IVF-ET after anti-TB chemotherapy is the most effective treatment to achieve pregnancy in infertile patients with pelvic TB. Because the presence of endometrial TB and resulting uterine synechia affects the outcome of IVF-ET, thorough evaluation for endometrium with endometrial biopsy and hysteroscopy is important to predict the prognosis of IVF-ET treatment.