Genital Tuberculosis as the Cause of Tuboovarian Abscess in an Immunosuppressed Patient

M Ilmer,I Mylonas,K Friese,F Bergauer

doi:10.1155/2009/745060

Abstract

Background. Although tuberculosis (TB) is a major health problem worldwide, primary extrapulmonary tuberculosis (EPTB), and in particular female genital tract infection, remains a rare event. Case Report. A 35-year-old human immunodeficiency virus (HIV) seropositive woman of African descent with lower abdominal pain and fever of two days duration underwent surgery due to left adnexal mass suggesting pelvic inflammatory disease. The surgical situs showed a four quadrant peritonitis, consistent with the clinical symptoms of the patient, provoked by a tuboovarian abscess (TOA) on the left side. All routine diagnostic procedures failed to determine the causative organism/pathogen of the infection. Histopathological evaluation identified a necrotic granulomatous salpingitis and specific PCR analysis corroborated Mycobacterium tuberculosis (M. Tb). Consequently, antituberculotic therapy was provided. Conclusion. In the differential diagnosis of pelvic inflammatory disease, internal genital tuberculosis should be considered. Moreover, physicians should consider tuberculous infections early in the work-up of patients when immunosuppressive conditions are present.

Highlights

Pelvic inflammatory disease (PID) is a common disorder of the upper female genital tract that can lead to formation of abscesses and peritonitis
We present a case about a 35-year-old, human immunodeficiency virus (HIV)-positive patient admitted to our hospital with fever and pain in the lower left abdominal quadrant, with a tuboovarial abscess caused by Mycobacterium tuberculosis
Initiation of an antiretroviral treatment (ART) against HIV was to be started at a later time point in order to not interfere with tuberculosis regimens [9]

Summary

Background

Tuberculosis (TB) is a major health problem worldwide, primary extrapulmonary tuberculosis (EPTB), and in particular female genital tract infection, remains a rare event. A 35-year-old human immunodeficiency virus (HIV) seropositive woman of African descent with lower abdominal pain and fever of two days duration underwent surgery due to left adnexal mass suggesting pelvic inflammatory disease. The surgical situs showed a four quadrant peritonitis, consistent with the clinical symptoms of the patient, provoked by a tuboovarian abscess (TOA) on the left side. All routine diagnostic procedures failed to determine the causative organism/pathogen of the infection. In the differential diagnosis of pelvic inflammatory disease, internal genital tuberculosis should be considered. Physicians should consider tuberculous infections early in the work-up of patients when immunosuppressive conditions are present

Introduction

Case Report

Findings

Discussion