#32 : Female Genital Tuberculosis with Primary Subfertility — A Case Report

Abstract

Background and Aims: Tuberculosis is a major health problem with worldwide incidence of about 10.4 million people TB in 2015, out of which more than 60% were in Asia. There is no single diagnostic test for female genital tuberculosis so diagnosis is made after considering various factors such as family history, general physical examination, culture and PCR tests and also the diagnostic hysteroscopy and laparoscopy. Here we report a case of asymptomatic female genital tuberculosis in which diagnosis was made on the basis of laparoscopic findings as well as histopathology. Method: Patient 30 years with no symptom, planned to have laparoscopy and proceed as workup for primary subfertility and ultrasound showing 44 * 22 mm cyst with internal echoes in right adnexal region, with impression of right endometriotic cyst. Results: Laparoscopy showed normal uterus. There was 0.5 * 0.6 cm granuloma on surface fundus of uterus, adhesions in Pouch of Doughlas. Right tube had gross hydrosalpinx with fimbrial phymosis, and golf stick appearance. Right ovary was buried under right tube and had cyst of size 4 * 5 cm, on drainage caseous material. Left tube had moderate hydrosalpinx and left ovary was completely buried in adhesions. No fill and spill of dye on dyes test. Adhesiolysis was done and anatomy restored. Right tubo ovarian mass drained and caseous material removed. Uterine fundal caseous material removed and collected for histopathology which confirmed the diagnosis. Giant cell with granuloma and caseous necrosis was confirmed on histopathology. Conclusion: Female genital tuberculosis is associated with late presentation due to asymptomatic nature of disease. Hysteroscopy and laparoscopy with microbiological tests on samples taken during laparoscopy has made the diagnosis near to confirmatory. Correct and complete medical treatment gives good results.