Endometritis granulomatosa por tuberculosis en mujer postmenopaúsica / Granulomatous tuberculosis endometritis in a posmenopausal woman

INTRODUCCIÓN: La tuberculosis (TBC) genital es una infección relativamente poco frecuente en la mujer. Afecta principalmente a mujeres menores de 40 años, y el motivo de consulta más usual es la esterilidad, de ahí la importancia de su diagnóstico precoz. CASO CLÍNICO clínico: Se presenta el caso de una paciente con dolor pélvico crónico que acude a nuestras consultas para valoración. Durante el estudio se toma biopsia dirigida de la cavidad endometrial diagnosticándose la presencia de granulomas no necrotizantes. Posteriormente se realiza un cultivo microbiológico que resulta positivo para micobacterias y se determina el DNA, mediante reacción en cadena de la polimerasa, de mycobacterium tuberculosis, como causante del cuadro. DISCUSIÓN: El diagnóstico definitivo de TBC requiere el aislamiento en cultivo del bacilo de Koch, aunque en los casos de TBC genital, al ser una entidad paucibacilar, puede no resultar positivo. En éste caso, sería suficiente el diagnóstico de presunción basado en la sospecha clínica y el hallazgo histológico de granulomas. CONCLUSIÓN: La tuberculosis genital es una entidad poco frecuente en nuestro medio, aunque es una causa importante de infertilidad femenina y su predominio generalmente se subestima debido a la naturaleza paucisintomática de la misma. El diagnóstico temprano y el tratamiento multidisciplinar son fundamentales.

INTRODUCTION: Genital tuberculosis (TB) is a relatively rare afection in women. It mainly affects women younger than 40 years, and the most frequent reason for consultation is sterility, therefore early diagnosis is important. CLINICAL CASE: We presented the case of a patient with chronic pelvic pain who comes to our consultations. During the study, we take an endometrial biopsy diagnosing the presence of non-necrotizing granulomas. Finally, we determined the mycobacterium tuberculosis DNA through the polymerase chain reaction and positive microbiological culture, as the cause of pathology. DISCUSSION: The definitive diagnosis of TB requires the isolation in culture of the Koch bacillus, although in genital TB cases, as it is a paucibacillary entity, it may not be positive. In this case, the presumptive diagnosis based on clinical suspicion and the histological granulomas would be enough. CONCLUSIONS: Genital tuberculosis is a rare entity in our environment, although it is an important cause of female infertility and its prevalence is generally underestimated due to its paucisymptomatic nature. Early diagnosis and multidisciplinary treatment are essential.

Tubercular Pyosalpinx Mimicking Ovarian Torsion.

Ovarian torsion is a gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females. Whereas Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent . In this case study, suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.

Evaluating PCR, culture & histopathology in the diagnosis of female genital tuberculosis.

Background & objectives: Genital tuberculosis (GTB) is one of the major causes for severe tubal disease leading to infertility. Unlike pulmonary tuberculosis, the clinical diagnosis of GTB is difficult because in majority of cases the disease is either asymptomatic or has varied clinical presentation. Routine laboratory values are of little value in the diagnosis. An absolute diagnosis cannot be made from characteristic features in hysterosalpingogram (HSG) or laparoscopy. Due to the paucibacillary nature of GTB, diagnosis by mycobacterial culture and histopathological examination (HPE) have limitations and low detection rate. The objective of this study was to evaluate the efficacy of PCR technique, culture and histopathological examination in the diagnosis of GTB in female infertility. Methods: This study included 72 infertile women who met the inclusion and exclusion criteria. After a detailed history and clinical examination all patients were subjected to investigations including pelvic sonogram, HSG and laparoscopy. Endometrial samples from were allocated for AFB smear, culture and HPE examination. Only 49 samples were available for PCR using IS 6110 and TRC4 primers. In seven patients peritoneal fluid was also taken for culture and PCR. Based on the clinical profile and laparoscopic findings, a diagnostic criteria was derived to suspect GTB. Specific diagnostic tests were evaluated against this diagnostic criterion. Results: Laparoscopy was suggestive of tuberculosis in 59.7 per cent of cases, AFB smear was positive in 8.3 per cent, culture was positive in 5.6 per cent, HPE positive in 6.9 per cent and PCR was positive in 36.7 per cent of cases. Based on the diagnostic criteria, GTB was suspected in 28 of the 49 cases. On evaluating against the diagnostic criteria, the sensitivity of PCR, HPE and culture were 57.1, 10.7, 7.14 per cent respectively. The concordance of results between the clinical criteria and specific diagnostic tests were analysed by Kappa measure of agreement. The culture and HPE showed mild agreement with the clinical criteria, whereas PCR showed a moderate agreement. PCR was positive in Two of the 21 cases in whom GTB was not suspected. False positive PCR in these two cases were ruled out by multiple areas of sampling and re-sampling in one case. The PCR results were negative in 12 of the 28 cases. PCR using TRC4 primers had a higher sensitivity (46.4%) than IS 6110 primers (25%) in detecting clinically suspected GTB. Interpretation & conclusions: Our results showed that conventional methods of diagnosis namely, HPE, AFB smear and culture have low sensitivity. PCR was found to be useful in diagnosing early disease as well as confirming diagnosis in clinically suspected cases. False negative PCR was an important limitation in this study.

Congenital tuberculosis.

We report a case of congenital tuberculosis diagnosed by liver biopsy in a 8-week-old infant presented with acute abdomen. Liver biopsy showed multiple lymphoepitheloid cell granulomas with Langhans' giant cells and central necrosis. The culture of caseous material from the liver showed Mycobacterium tuberculosis . Antituberculous treatment was started. Endometrial biopsy in the asymptomatic mother confirmed the source of infection.

Primary amenorrhoea: analysis of 48 cases.

The clinical analysis of 48 patients of primary amenorrhoea seen at All India Institute of Medical Sciences, New Delhi for a period of 3 years, was performed. Twenty-six patients (54.2%) had muellerian anomalies, 11 (22.9%) had hypogonadotropic hypogonadism, 8 (16.6%) had hypergonadotropic hypogonadism and 3 (6.3%) had genital tuberculosis. The study highlights the role of transabdominal sonography in the work up of these cases. It suggests the reproductive potential of these cases by visualising the genital organs and makes laparoscopy and intravenous pyelography obsolete and selects the cases who deserve to be further investigated.

Tuberculose genital e amenorréia primária: descriçäo de caso / Primary amenorrhea and tuberculosis: case report

A associaçao de amenorréia primária e tuberculose genital é rara. Nesse relato descreve-se o caso de uma mulher de 16 anos de idade com história de amenorréia primária com presença de caracteres sexuais secundários normais. Por suspeita clínica de anomalia mulleriana foi feito laparotomia exploradora que foi inconclusiva, e o diagnóstico foi direcionado pelo PPD fortemente reator, sendo definido após pela histeroscopia e análise histológica do material endometrial.

Tuberculous cervicitis: a clinicopathological and bacteriological study.

Seven cases of tuberculous cervicitis were detected out of 91 culturally and histologically established cases of uterine tuberculosis. There was simultaneous infection of cervix and endometrium in 4 cases and only cervical lesion in 3 cases. Two women gave a definite past history of primary extragenital tuberculosis-peritonitis in one and pulmonary lesion in the other. Clinically, cervix was predominantly hypertrophied in 4 cases and predominantly ulcerative in 3 cases. Acid-fast bacilli (Myco tuberculosis) were recovered from 5 cases, in abundance from 2 hypertrophied lesions and in sparse number from the 3 predominantly ulcerative lesions. Histological examination revealed pseudo-epitheliomatous hyperplasia with poor cellular response in the hypertrophied cervix and non-caseating tuberculous granuloma in predominantly ulcerative cervix. All the patients were from Darjeeling hills where endemic tuberculosis is high. An awareness of this entity is necessary while dealing with the cervical lesion of these patients.

Tuberculous endometritis in hills of Darjeeling: a clinicopathological and bacteriological study.

Combined histological and bacteriological investigations of 800 specimens of nonpregnant endometrial curettings of 15 to 60 years age group of hill women of Darjeeling District were carried out for detection of tuberculous endometritis. The principal complaints were infertility (47.5 per cent), abnormal uterine bleeding (30.75 per cent), amenorrhoea (11.25 per cent), leucorrhoea (6.25 per cent), and miscellaneous conditions (pelvic pain and pyometra) (4.25 per cent) cases. By histological examination alone, only 10.9 per cent cases could be diagnosed while by combined study the incidence rate was 11.8 percent, an increase in the diagnostic acumen by more than 10.3 per cent. Bacteriological study was of greater value in doubtful cases where there was absence of tuberculous granuloma or epithelioid cell but presence of nonspecific inflammatory cells along with variable degree of necrosis of glandular epithelia. The incidence of M.tuberculosis was 97.7 percent while that of atypical mycobacteria was 2.3 per cent. Thus simultaneous use of culture and biopsy yielded better results. Our prevalence is a little higher than other reports from India. In cold weather at a high altitude, the tubercle bacilli survive longer in fomites which serve as important sources of infection in Darjeeling. Women of third decade are more frequently affected (43.2 per cent).

Female genital tuberculosis--a retrospective clinico-pathologic study of 501 cases.

A retrospective clinico-pathological study of 501 cases of female genital tuberculosis (FGTB) observed from 1974 to 1991 was conducted. The frequency of FGTB was 1.8% in 1974 rising to 2.4% in 1982, thereafter showing a steady decline to 0.8% in 1989 and onwards. Two thirds of the patients were infertile and between 17 to 40 years of age, while 82.3% of all cases of FGTB were between 20-30 years of age. Involvement of the endometrium was noted in 99.5%, fallopian tubes in 94.7%, cervix in 81.5%, ovaries in 62.5% and vulva in 0.2% of cases. Extensive caseous lesions in the genital tract were a notable feature in elderly women 70 years of age. Staining for Acid Fast Bacilli was not found to be useful, however follow-up biopsies from endometrium and cervix in 45 cases on anti-tubercular therapy showed complete disappearance of the granulomas.

Abscesso tuberculoso tubário e peritoneal: relato de caso. Estatística de tuberculose genital num Serviço de Ginecologia / Tuberculous tubal and peritoneal abscess: case report. Statistics of genital tuberculosis in a Gynecological Service

Descreve-se um caso de abscesso tubário e peritoneal em paciente de 22 anos, operada e seguida de tratamento médico. Havia antecedente de derrame pleural e ascite. A pesquisa de 33.651 prontuários de pacientes matriculadas no Serviço, num período de 18 anos (1972-1990), revelou apenas quatro casos de tuberculose genital feminina comprovados pelo exame histológico. Dois casos eram de peças cirúrgicas e um relacionava-se a curetagem para diagnóstico de metrorragia. Foram excluídos os casos de suspeita radiológica de tuberculose genital atendidos no ambulatório de infertilidade, sem comprovaçäo do exame histológico e da cultura do endométrio. A incidência da doença foi de 0,84127 por cento.

Endometrite e cervicite tuberculosa associadas a carcinoma in situ do colo uterino na pós-menopausa: relato de um caso / Postmenopausal tuberculosis cervicitis and endometritis with carcinoma in situ of the uterine cervix

É relatado um caso de endometrite e cercicite tuberculosa associadas a carcinoma in situ do colo uterino numa mulher na pós-menopausa. A paciente havia se submetido a uma amputaçäo de colo uterino por carcinoma in situ e durante o seguimento foi observada recidiva do processo, após um ano da cirurgia. Foi entäo realizada uma histerctomia total com anexectomia bilateral, cujo resultado histopatológico revelou a associaçäo de endometrite e cervicite tuberculosa com carcinoma in situ do colo uterino. As trompas e os ovários näo estavam afetados pelo processo tuberculoso. É ressaltada a raridade do caso, e feita uma revisäo da literatura sobre o assunto