Florid genital tuberculosis co-existing with adenomyosis and evading diagnosis

Radha B. P. Thangappah, Sahitya Meda, Roohi Tabassum
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2020 · vol. 10(1) , pp. 390 · doi:10.18203/2320-1770.ijrcog20205806 · W3114472422
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This case report describes florid genital tuberculosis co-existing with adenomyosis, presenting as a diagnostic challenge due to mimicking other gynecological conditions.

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The paper reports a case of florid genital tuberculosis involving the uterus, cervix, ovaries, and tubes in a young female, occurring alongside uterine adenomyosis. It describes how genital tuberculosis can be silent or mimic other gynecologic conditions, and specifically that a “cold abscess” evaded diagnosis by masquerading as bilateral ovarian endometriomas on imaging. The authors note that even with extensive investigations, including molecular studies, the diagnosis of genital tuberculosis can be missed. This paper is centrally about endometriosis and adenomyosis overlap — it reports genital tuberculosis co-existing with adenomyosis and imaging findings that mimicked ovarian endometriomas, illustrating a differential diagnosis problem in endometriosis/adenomyosis research contexts.

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Abstract

When tuberculosis affects genital organs of young females, the disease often remains silent or may present with symptoms which are common to other Gynaecological conditions as well. The diagnosis of genital tuberculosis is challenging and the diagnosis can be missed even with extensive investigations including molecular studies. A case of florid tuberculosis affecting the uterus, cervix, ovaries and tubes, co-existing with adenomyosis of the uterus and the cold abscess masquerading as bilateral ovarian endometriomas is reported.
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Florid genital tuberculosis co-existing with adenomyosis and evading diagnosis DOI: https://doi.org/10.18203/2320-1770.ijrcog20205806Keywords: Genital tuberculosis, Diagnosis, MRI featuresAbstract When tuberculosis affects genital organs of young females, the disease often remains silent or may present with symptoms which are common to other Gynaecological conditions as well. The diagnosis of genital tuberculosis is challenging and the diagnosis can be missed even with extensive investigations including molecular studies. A case of florid tuberculosis affecting the uterus, cervix, ovaries and tubes, co-existing with adenomyosis of the uterus and the cold abscess masquerading as bilateral ovarian endometriomas is reported. Metrics References Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician. 2005;72:1761-8. De Vynck WE, Kruger TF, Joubert JJ, Scott F, Vander Merwe JP, Hulme VA, Swart Y. Genital tuberculosis associated with female infertility in the Western Cape. S Afr Med. 1990;77(12):630-1. Deshmukh K, Lopez J, Naidu AK, Gaurkhed MD, Kasbawala M.V. Place of Laparoscopy in pelvic tuberculosis in infertile women. Jl Obstet Gynec India. 1987;37(2):289-91. Bhanu NV, Urvashi B, Singh UB, Chakraborthy M, Suresh N, Arora J, Rana T, Takkar D, Seth P. Improved diagnostic value of PCR in the diagnosis if female genital tuberculosis leading to infertility. J Med Microbiol. 2005;54:927-31. Soltys MA. An anti tuberculous substance in tuberculous organs. J comp Pathol. 1953;63(2):147-52. Klein TA, Richmond JA, Mishell DR. Pelvic tuberculosis. Obstet Gynecol. 1976;48(1):99-104. Restrepo BI, Gomez DI, Shipley GL, Mc Cormick JB, Fisher – Hoch SP. Selective enrichment and detection of mycobacterial DNA in paucibacillary specimens. J Microbiol Methods. 2006;67(2):220-9. Schaefer G. Tuberculosis of the female genital tract. Clin Obstet Gynecol. 1970;13:965-97. Varma TR. Genital tuberculosis and subsequent fertility. Int J Gynecol Obstet. 1991;35:1-11. Himanshu R, Shanti R, Sharika R. Use of polymerase chain reaction for diagnosis of endometrial tuberculosis in high risk subfertile women in an endemic zone. J. Obstet Gynecol India. 2003;53:260-3.

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