Female genital tuberculosis in an infertility patient resulting in destruction of ovarian tissue: A case report

Female genital tuberculosis is an important cause of infertility in endemic regions; it most often affects the fallopian tubes and uterine endometrium, though involvement of the ovaries, cervix, and vagina/vulva have also been reported. This report concerns the case of a 30-year-old nulligravid woman who presented for evaluation following discovery of a right adnexal mass in the setting of right-sided abdominal pain. On initial evaluation, the patient also reported a history of secondary amenorrhea and the inability to conceive for six months. Laparoscopic and hysteroscopic findings were concerning for extensive adhesive disease resulting in loss of normal fallopian tube and uterine architecture, as well as complete obliteration of the right ovary. Ultimately, the patient's history and surgical findings were highly suggestive of female genital tuberculosis with sequelae resulting in diffuse pelvic organ disease. An endometrial biopsy confirmed the diagnosis with a positive tuberculosis PCR and acid-fast bacillus culture. This case highlights the importance in considering female genital tuberculosis in the workup of infertility, the obstacles to definitive diagnosis, and the detrimental impact longstanding disease can have on pelvic organ function. Additionally, the loss of normal ovarian tissue in this patient may provide a pathophysiologic basis for the previously established association between diminished ovarian reserve and female genital tuberculosis.