Large bilateral tubercular pyosalpinx in a young woman with genitourinary malformation: a case report

详细信息    查看全文

• 作者：Jacqueline Gascón ; Pedro Acién
• 关键词：Genital tuberculosis ; Hysterosalpingography ; Pelvic kidney ; Pyosalpinx ; Infertility ; Uterine malformation
• 刊名：Journal of Medical Case Reports
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：8
• 期：1
• 全文大小：555 KB
• 参考文献：Tuberculosis genital femenina. Progr Obstet Ginecol 46: pp. 523-530 CrossRef
  1. Varma, TR (1991) Genital tuberculosis and subsequent fertility. Int J Gynaecol Obstet 35: pp. 1-11 CrossRef
  2. Bapna, N, Swarankar, M, Kotia, N (2005) Genital tuberculosis and its consequences on subsequent fertility. J Obstet Gynecol India 55: pp. 534-537
  3. Tripathy, SN (2002) Infertility and pregnancy outcome in female genital tuberculosis. Int J Gynecol Obstet 76: pp. 159-163 CrossRef
  4. Ghosh, K, Ghosh, K, Chowdhury, JR (2011) Tuberculosis and female reproductive health. J Postgrad Med 57: pp. 307-313 CrossRef
  5. Dam, P, Shirazee, HH, Goswami, SK, Gosh, S, Ganesh, A, Choudhary, K (2006) Role of latent tuberculosis in repeated IVF failure in Indian setting. Gynecol Obstet Invest 61: pp. 223-227 CrossRef
  6. Gurbuz, A, Karateke, A, Kabaca, C, Kir, G, Cetingoz, E (2006) Peritoneal tuberculosis simulating advanced ovarian carcinoma, is clinical impression sufficient to administer neoadjuvant chemotherapy for advanced ovarian cancer?. Int J Gynecol Cancer 16: pp. 307-312 CrossRef
  7. Kulshrestha, V, Kriplani, A, Agarwal, N, Singh, VB, Rana, T (2011) Genital tuberculosis among infertile woman and fertility outcome after antitubercular therapy. Int J Gynecol Obstet 113: pp. 229-234 CrossRef
  8. Balasch, J, Coll, O, Jove, I, Moreno, V, Mulet, J, Vanrell, JA (1991) Diethylestilbestrol-induced müllerian abnormalities, septate uterus, genital tuberculosis and twin pregnancy with term delivery after IVF. Hum Reprod 6: pp. 690-693 CrossRef
  9. Akbulut, S, Arikanoglu, Z, Basbug, M (2011) Tubercular tubo-ovarian cystic mass mimicking acute appendicitis: a case report. J Med Case Reports 5: pp. 363 CrossRef
  10. Aliyu, MH, Aliyu, SH, Salihu, HM (2004) Female genital tuberculosis: a global review. Int Fertil Womens Med 49: pp. 123-136
  11. Mondal, SK (2013) Histopathologic analysis of female genital tuberculosis: a fifteen-year retrospective study of 110 cases in eastern India. Turk Patoloji Derg 29: pp. 41-45 CrossRef
  12. Ilmer, M, Bergauer, F, Friese, K, Mylonas, I (2009) Genital tuberculosis as the cause of tuboovarian abscess in an immunosuppressed patient. Infect Dis Obstet Gynecol 2009: pp. 745060 CrossRef
  13. Boss, JD, Shah, CT, Oluwole, O, Sheagren, JN (2012) TB peritonitis mistaken for ovarian carcinomatosis based on an elevated CA-125. Case Rep Med 2012: pp. 215293 CrossRef
  14. Aslam, MF, Mukherjee, P, Khulpateea, N, Ghayoori, R (2010) Unusual presentation of genital tract tuberculosis. J Obstet Gynaecol 30: pp. 636-642 CrossRef
  
• 刊物主题：Medicine/Public Health, general; General Practice / Family Medicine; Public Health; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1752-1947

文摘

Introduction Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent or presents with very few specific symptoms. In adolescents and young women, tuberculosis can also present with hypogastric recurrent symptoms and affectation of the general state, but because in our country genital tuberculosis is uncommon, its diagnosis is unlikely. Case presentation We describe the case of an 18-year-old Spanish woman who had been sexually active for 1?year, nulliparous, who presented with hypogastric discomfort and repeated urinary symptoms complicated with pelvic inflammatory disease after a hysterosalpingography. Genital tuberculosis was not suspected. The echographical findings and tumor markers mimicked those of ovarian tumors, and she was also a carrier of a genitourinary malformation (pelvic kidney and septate uterus). A laparotomy was performed and revealed large pelvic abscesses. On her right adnexum, the large pyosalpinx was free (floating pyosalpinx). Drainage, adhesiolysis and bilateral salpingectomy were performed, and cultures were taken. Histopathological study showed bilateral granulomatous abscessificated salpingitis with suspicion of genital tuberculosis, and cultures were positive for Mycobacterium tuberculosis. She followed a tuberculostatic treatment for 6?months. Eight years later, she presents with normal menstruations and is waiting for an in vitro fertilization cycle. Conclusions No other reported case showing similar association of genital tuberculosis and genitourinary malformation was found. The associated genitourinary malformation in this case probably has no relation but it could contribute to diagnosis delay and/or to reactivate the pathology. The hysterosalpingographical findings and the observation of a floating pyosalpinx must alert the clinician to genital tuberculosis, but the diagnosis is suggested by the histopathological studies and confirmed by cultures. In this case study, the necessity of considering the risk of pelvic inflammatory disease reactivation after hysterosalpingography, of suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.