Tuberculosis (TB) is a disease with a high burden, with most patients in low and middle income countries (LMIC). In Western countries however, this disease is rare, but with the increasing number of migrants it becomes more relevant. Especially in women with fertility issues, TB is not the most likely diagnosis and therefore difficult to discover and treat. If TB is not detected at an early stage, it can have major consequences for fertility and pregnancy outcomes. Screening should be suggested in women originated from high endemic countries with unexplained fertility loss, or during first trimester screening. QuantiFERON testing and PCR sampling for TB should be the golden standard. This case report describes fertility issues and an immature delivery in a young woman caused by extrapulmonary TB in the genital tract. With this case report, we hope to draw attention to this disease so that early detection can take place and serious outcome can be prevented.
Tuberculosis (TB) is a disease that primarily affects low and middle income countries (LMICs) but is becoming more relevant in Western countries due to increasing migration from high TB burden countries. It is especially difficult to detect in women with fertility issues as it mimics other more common causes. Delayed diagnosis of TB can result in fallopian tube and endometrial pathology leading to subfertility and pregnancy loss. This case report describes a 34-year-old woman from Ivory Coast who was diagnosed with intrauterine tuberculosis after hysteroscopic evacuation of suspected retained placental tissue following an immature delivery. The patient had a complicated fertility history, including pelvic inflammatory disease and IVF/ICSI procedures, before becoming pregnant at the age of 38. She delivered prematurely at 22 weeks with a retained placenta. A diagnosis of TB was confirmed after pathology revealed granulomatous inflammation, without signs of placental tissue, and further testing confirmed rifampicin-resistant TB. The patient underwent a 15-month course of multi-drug-resistant TB treatment, which postponed her pregnancy wish. The case highlights the challenge of diagnosing genital TB in the female genital tract during subfertility investigations and after a complicated pregnancy in a woman without a history of or symptoms of TB. It underscores the importance of considering TB in the differential diagnosis of subfertility. Screening should be considered in women originating from high endemic countries with unexplained fertility loss and during first trimester screening.
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