Dr. Mrinmayi S. Dharmadhikari (M.S,DNB,MRCOG), Consultant, Ashvini Hospital, Mumbai(410206), India
Introduction
Female genital tuberculosis (FGTB) is a chronic disease with atypical symptoms.Diagnosis poses a challenge with no single test available for accurate diagnosis. Prevalence rates are as high as 3–26% in low and middle income countries (LMICs) like India.
Tissue biopsy was taken for histopathology, microscopy,culture and CBNAAT(Cartridge Based Nucleic Acid Amplification Test)
Objective -To highlight
● the wide spectrum of presentation of genital
tuberculosis
● role of hysterolaparoscopy in diagnosis and
management.
Method
● Four patients of subfertility ultimately diagnosed as
cases of genital TB are presented here.
● Each case had a varied presentation –
Patient A: Chronic pelvic pain
Patient B: Subfertility with hysterosalpingography
(HSG) suggestive of bilateral tubal block and
hydrosalpinges
Patient C: Subfertility with a narrow T-shaped
uterine cavity on HSG
Patient D: Unexplained infertility.
● All were offered hystero-laparoscopy for the above
indications at our medical center in Mumbai, India.
Results: All patients were started on Anti Tubercular
Treatment (ATT) based on the following results-
● Patient A – CBNAAT positive for mycobacterium
tuberculosis with history of pulmonary tuberculosis.
● Patient B – laparoscopic picture of tuberculosis with history
of tuberculosis contact.
● Patient C – CBNAAT positive for mycobacterium
tuberculosis on endometrial biopsy with history of
tuberculosis contact.
● Patient D – histopathological picture of tuberculosis with
epitheloid granuloma on endometrial biopsy.
Outcome
● Patient A is currently on ATT.
● Patient B opted for in vitro fertilization after
bilateral salpingectomy for hydrosalpinges.
● Patient C conceived following treatment and has
delivered a healthy baby.
● Patient D was lost to follow up.
Conclusion
In countries like India with a high burden of the disease, hysterolaparoscopy plays an important role in the management of this silent disease which poses numerous diagnostic challenges.
References 1.Sharma JB. Current diagnosis and management of female genital tuberculosis. J Obstet Gynaecol India.
2015;65(6):362–371
