Adnexal torsion caused by tuberculous pyosalpinx: An uncommon case report of urogenital tuberculosis

Abstract

Background According to the World Health Organization, TB is a global public health problem and it remains in 2020 the deadliest infectious disease in the world, ahead of Covid19 ( Global Tuberculosis Report 2020 , 2020). Morocco is an endemic area with more than 30,000 new cases of all forms of tuberculosis each year ( Plan stratégique national 2018-2021 de lutte antituberculeuse , 2018). UGTB is the second most frequent localization after lymph node involvement and is responsible for 30 to 40% of all extrapulmonary cases. Case presentation We hereby present the uncommon case of a 27-year-old virgin woman with unremarkable medical and surgical histories, who presented at the emergency department for left-sided pelvic pain of acute installation. An exploratory laparotomy using a Pfannenstiel incision, demonstrated a peritoneal effusion of low abundance with a twisted left ovary and a huge pyosalpinx. Detorsion was then carefully performed, with improvement in color of the ovary and decrease in edema within 10 min. Histopathological study of the Fallopian tube biopsy revealed granulomatous abscessificated salpingitis with genital tuberculosis. Thus, the patient received her anti-tuberculosis treatment with a course of 6 months of 2HRZE/4HR. Conclusions In view of the resurgence of cases of tuberculosis of all forms, the importance of prevention and screening should not be underestimated, especially in endemic areas. In fact, only BCG at birth and the correct treatment of any primary tuberculosis infection, whatever its location, will make it possible to reduce the consequences of this affection and avoid the tragedy of the home without children.

A Rare Case of Isolated Ovarian Tuberculosis Incidentally Found During In Vitro Fertilization Workup in a Young Woman With Primary Infertility

“…Tuberculosis (TB) is a chronic infectious disease commonly caused by Mycobacterium tuberculosis (99% of the cases) [ 1 ]. TB affects millions of individuals worldwide and over one million people die from TB each year [ 2 ]. The infection mainly affects the lungs, but extrapulmonary involvements are also common [ 2 ].…”

“…TB affects millions of individuals worldwide and over one million people die from TB each year [ 2 ]. The infection mainly affects the lungs, but extrapulmonary involvements are also common [ 2 ]. The lymph node cases of TB represent the most frequent forms of extrapulmonary TB (EPTB), followed by urogenital TB (UGTB), with an estimated prevalence of 30-40% among all EPTB cases [ 2 ].…”

“…The infection mainly affects the lungs, but extrapulmonary involvements are also common [ 2 ]. The lymph node cases of TB represent the most frequent forms of extrapulmonary TB (EPTB), followed by urogenital TB (UGTB), with an estimated prevalence of 30-40% among all EPTB cases [ 2 ]. UGTB usually results from hematogenous or lymphatic dissemination of the pathogen from a primary infected lung or other organs, but sexual transmission through a partner with genital TB has also been described [ 2 , 3 ].…”

“…However, patients with this condition may present with low-grade fever, weight loss, chronic pelvic pain, menstrual irregularities, vaginal bleeding, secondary amenorrhea, or a pelvic mass [ 4 , 6 ]. Its diagnosis is often delayed, and it is frequently misdiagnosed as ovarian cancer due to the varying nature of its clinical presentations [ 2 , 4 ]. The definitive diagnosis of TB requires bacteriological evidence via culture on Löwenstein-Jensen (LJ) medium or by acid-fast staining with the Ziehl-Neelsen technique.…”

“…The definitive diagnosis of TB requires bacteriological evidence via culture on Löwenstein-Jensen (LJ) medium or by acid-fast staining with the Ziehl-Neelsen technique. However, histological evidence is usually accepted in UGTB due to the paucibacillary forms in this entity [ 1 , 2 , 7 ]. We present a rare case of isolated ovarian TB in a 40-year-old woman with four years of infertility, incidentally diagnosed by laparoscopy during in vitro fertilization (IVF) workup.…”