What is the red round ulcer in the cervix?

Abstract

Uterine cervix tuberculosis (TB) is very rare, and accounts for 0.1–0.65% of TB, with atypical symptoms. The symptoms of cervix TB are diverse, and include amenorrhea, menstrual irregularities, infertility, vaginal discharge, and uterine bleeding [1]. We found uterine cervix tuberculosis (TB) by Gupta very interesting [2]. Our postmenopausal case and Gupta’s case about 20-year-old lady gave the educational guideline to diagnosis of uterine TB in endemic TB area. A 53-year-old multiparous postmenopausal woman presented with vaginal discharge refractory to antibiotics from 3 months at local clinic. She had been performed a laparoscopic tubal sterilization. Her husband had died of pulmonary emphysema 20 years earlier. She had no sexual partner after her husband’s death. Her son-in-law had developed pulmonary TB 10 years earlier. In the past 3 months, she had lost 4 kg of body weight while on a diet of kohlrabi and brown rice. She was worked up for the microbiologic culture, including Chlamydia trachomatis, Neisseria gonorrhea, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Trichomonas vaginalis, Gardnerella vaginalis, Candida albicans, and herpes simplex virus 1 and 2. All the ten results were negative. We performed human papilloma virus (HPV) genotyping of cervix. It was positive for HPV type 16. A liquid-based Pap test showed reactive cellular changes with inflammatory findings. Pelvic examination revealed multiple red round ulcerations (Fig. 1). A colposcopy-guided cervix biopsy revealed ulcerated fragments of markedly inflamed granulation tissue and granuloma of the cervix with severe chronic active inflammation (Fig. 2). A nested PCR and serological test for M. tuberculosis were positive. The chest X-ray, gynecologic ultrasonography and X-ray computed tomography (CT) of pelvic cavity showed no abnormalities. Thus, we were able to confirm as primary cervix TB. She responded to antitubercular treatment (Fig. 3).