Tuberculosis of the uterine cervix

Abstract

Tuberculosis (TB) is a bacterial infection frequently seen in less developed countries. It is a frequent cause of chronic pelvic inflammation and infertility. The incidence was reported to be 58/100,000 population in Taiwan in 2009 [1]. While lung and lymph node localization are common, genital organ involvement is more rare. Tuberculosis involvement in the female genital tract in almost all cases is secondary to extragenital tuberculosis [2]. It has been estimated that 5e13% of the cases of pulmonary TB develop a genital infection [3]. The fallopian tubes are affected most commonly (90%), followed by the endometrium (50%) and the ovaries (10e30%). The cervix is rarely involved and accounts for 5e24% of the cases of genital tract tuberculosis [4]. We describe here a case of secondary amenorrhea with cervical tuberculosis, along with the colposcopic findings. A 21-year-old Vietnamese woman presented with amenorrhea and primary infertility over the past 4 years. Her marriage brought her to Taiwan. Her menarche had occurred at 13 years of age. Her menstrual history was uneventful until she was 18 years old, when she had an episode of irregular spotting and was treated in her country. Then she came to Taiwan. No menstruation has been noted since her arrival. We conducted hormonal tests at our hospital, including folliclestimulating hormone, luteinizing hormone, estradiol, prolactin, testosterone, and thyroid function, which all fell within normal levels. The uterine size was 5.7 3.1 cm via ultrasound. Pelvic and colposcopic examinations revealed vegetative growth at the 3 o’clock position of the uterine cervix and multiple yellowish caseous nodules covering the entire cervix (Fig. 1). We did a cervical punch biopsy. The histologic slide showed granuloma formation composed of histiocytes and multinucleated giant cells (Fig. 2). Occasional acid-fast (þ) bacilli were seen under acid-fast stain. A TB culture of the cervix revealed Mycobacterium tuberculosis,