Endometritis granulomatosa por tuberculosis en mujer postmenopaúsica / Granulomatous tuberculosis endometritis in a posmenopausal woman

INTRODUCCIÓN: La tuberculosis (TBC) genital es una infección relativamente poco frecuente en la mujer. Afecta principalmente a mujeres menores de 40 años, y el motivo de consulta más usual es la esterilidad, de ahí la importancia de su diagnóstico precoz. CASO CLÍNICO clínico: Se presenta el caso de una paciente con dolor pélvico crónico que acude a nuestras consultas para valoración. Durante el estudio se toma biopsia dirigida de la cavidad endometrial diagnosticándose la presencia de granulomas no necrotizantes. Posteriormente se realiza un cultivo microbiológico que resulta positivo para micobacterias y se determina el DNA, mediante reacción en cadena de la polimerasa, de mycobacterium tuberculosis, como causante del cuadro. DISCUSIÓN: El diagnóstico definitivo de TBC requiere el aislamiento en cultivo del bacilo de Koch, aunque en los casos de TBC genital, al ser una entidad paucibacilar, puede no resultar positivo. En éste caso, sería suficiente el diagnóstico de presunción basado en la sospecha clínica y el hallazgo histológico de granulomas. CONCLUSIÓN: La tuberculosis genital es una entidad poco frecuente en nuestro medio, aunque es una causa importante de infertilidad femenina y su predominio generalmente se subestima debido a la naturaleza paucisintomática de la misma. El diagnóstico temprano y el tratamiento multidisciplinar son fundamentales.

INTRODUCTION: Genital tuberculosis (TB) is a relatively rare afection in women. It mainly affects women younger than 40 years, and the most frequent reason for consultation is sterility, therefore early diagnosis is important. CLINICAL CASE: We presented the case of a patient with chronic pelvic pain who comes to our consultations. During the study, we take an endometrial biopsy diagnosing the presence of non-necrotizing granulomas. Finally, we determined the mycobacterium tuberculosis DNA through the polymerase chain reaction and positive microbiological culture, as the cause of pathology. DISCUSSION: The definitive diagnosis of TB requires the isolation in culture of the Koch bacillus, although in genital TB cases, as it is a paucibacillary entity, it may not be positive. In this case, the presumptive diagnosis based on clinical suspicion and the histological granulomas would be enough. CONCLUSIONS: Genital tuberculosis is a rare entity in our environment, although it is an important cause of female infertility and its prevalence is generally underestimated due to its paucisymptomatic nature. Early diagnosis and multidisciplinary treatment are essential.

Endometrial Tuberculosis: Hysteroscopic Findings of a Clinical Case.

Endometrial tuberculosis is a rare diagnosis in the postmenopausal period, and it can mimic a carcinoma. The present article describes the case of a 54-year-old female patient with weight loss, abdominal pain, and ascites. An ultrasonography showed endometrial thickening, and a video hysteroscopy revealed a uterine cavity with formations with cotton aspect covering the entire endometrial surface and the tubal ostia. An anatomopathological evaluation diagnosed endometrial tuberculosis. The treatment was with a standardized therapeutic scheme (ethambutol, isoniazid, pyrazinamide and rifampicin), and the patient evolved with clinical improvement and normal uterine cavity at hysteroscopy. Considering the lack of pathognomonic hysteroscopic findings of the disorder, it is important to disclose the images of the case.

A tuberculose endometrial é um diagnóstico raro na pós-menopausa e pode mimetizar um carcinoma. O presente artigo descreve o caso de uma paciente de 54 anos com perda de peso, dor abdominal e ascite. A ultrassonografia mostrou espessamento endometrial, e a histeroscopia por vídeo revelou uma cavidade uterina com formações que apresentavam aspecto de algodão cobrindo toda a superfície endometrial e os óstios tubários. Uma avaliação anatomopatológica diagnosticou tuberculose endometrial. O tratamento foi com esquema terapêutico padronizado (etambutol, isoniazida, pirazinamida e rifampicina), e a paciente evoluiu com melhora clínica e cavidade uterina normal na histeroscopia. Considerando a falta de achados histeroscópicos patognomônicos do distúrbio, é importante divulgar as imagens do caso.

Endometrial tuberculosis: hysteroscopic findings of a clinical case / Tuberculose endometrial: Achados histeroscópicos de um caso clínico

Abstract Endometrial tuberculosis is a rare diagnosis in the postmenopausal period, and it can mimic a carcinoma. The present article describes the case of a 54-year-old female patient with weight loss, abdominal pain, and ascites. An ultrasonography showed endometrial thickening, and a video hysteroscopy revealed a uterine cavity with formations with cotton aspect covering the entire endometrial surface and the tubal ostia. An anatomopathological evaluation diagnosed endometrial tuberculosis. The treatment was with a standardized therapeutic scheme (ethambutol, isoniazid, pyrazinamide and rifampicin), and the patient evolved with clinical improvement and normal uterine cavity at hysteroscopy. Considering the lack of pathognomonic hysteroscopic findings of the disorder, it is important to disclose the images of the case.

Resumo A tuberculose endometrial é um diagnóstico raro na pós-menopausa e podemimetizar um carcinoma. O presente artigo descreve o caso de uma paciente de 54 anos com perda de peso, dor abdominal e ascite. A ultrassonografia mostrou espessamento endometrial, e a histeroscopia por vídeo revelou uma cavidade uterina com formações que apresentavam aspecto de algodão cobrindo toda a superfície endometrial e os óstios tubários. Uma avaliação anatomopatológica diagnosticou tuberculose endometrial. O tratamento foi com esquema terapêutico padronizado (etambutol, isoniazida, pirazinamida e rifampicina), e a paciente evoluiu com melhora clínica e cavidade uterina normal na histeroscopia. Considerando a falta de achados histeroscópicos patognomônicos do distúrbio, é importante divulgar as imagens do caso.

[Genital tuberculosis: atypical manifestation in the pregnancy. Case report]. / Tuberculosis genital: manifestacián atípica durante el embarazo. Reporte de un caso.

BACKGROUND: In the last years has been an increase in cases of tu- berculosis, representing a global health problem that is also reflected in an increased of cases in pregnant population. Especially in developed countries has been observed a direct relation with VIH patients,and groups of immigrants from countries where the infection is endemic. Tuberculous disease during pregnancy presents good outcome if it is diagnosed and treated properly. CASE REPORT: We present the case of a romanian patient with uncon- trolled 23 weeks gestation that enters with the suspicion of chorioam- nionitis and after late septic miscarriage and clinical sepsis criteria, leaks out of the hospital reentering with signs of neurologic involvement and pelviperitonitis as a result of genital tuberculous. Diagnosed with tuber- culous meningitis and disseminated with a grim evolution until death.

Endometritis tuberculosa sin foco primario y dolor pélvico crónico / Tuberculous endometritis with no primary focus and chronic pelvic pain

Antecedentes: La tuberculosis genital y la endometritis tuberculosa es una forma de tuberculosis que continúa siendo frecuente en los países en desarrollo y habitualmente es secundaria a un foco primario pulmonar. Puede cursar de forma asintomática, o bien, producir síntomas como infertilidad primaria o secundaria, alteraciones menstruales o dolor pélvico crónico, entre otros. Caso clínico: Se presenta el caso de una paciente de 47 años en estudio por ginecología y urología por dolor pélvico crónico y sintomatología urinaria inespecífica de aproximadamente 6 meses de evolución. La ecografía transvaginal muestra contenido intracavitario escaso sugerente de piometra e imágenes trabeculares compatibles con sinequias uterinas. Mediante aspirado endometrial se extrae pus y muestra endometrial que se remite para estudio anatomopatológico. Tras el informe anatomopatológico que diagnostica inflamación crónica granulomatosa necrotizante, se solicita estudio por PCR y cultivo para micobacteriumm tuberculosis, siendo ambos positivos para el microorganismo. De este modo, se diagnosticó como endometritis tuberculosa sin existir afectación de otros órganos tras el estudio completo. Se realizó tratamiento con etambutol hidrocloruro, isoniacida, pirazinamida y rifampicina durante 2 meses y pirazinamida e isonicida durante 7 meses adicionales. Al final del tratamiento, la paciente mostraba clara mejoría de los síntomas y a la ecografía desaparición de la colección intracavitaria uterina.

Background: Genital tuberculosis and endometritis tuberculosa is a form of tuberculosis which remains prevalent in developing countries and is usually secondary to a pulmonary primary focus. It may be asymptomatic, or may produce symptoms such as primary or secondary infertility, menstrual disorders or chronic pelvic pain, among others. Clinical case: We present the case of a patient of 47-year who was studied by ginecology and urology for chronic pelvic pain and unspecific urinary symptoms since about 6 months. In transvaginal ultrasound pyometra and trabecular images compatible with uterine synechiae were observed. Endometrial samples were obtaining and sent for histopathologic examination which was informed of chronic necrotizing granulomatous inflammation. We asked for PCR and culture for tuberculosis micobacteriumm, both being positive for the microorganism. Thus, she was diagnosed of endometritis tuberculosa without involvement of other organs after complete study. She performed a treatment with ethambutol hydrochloride, isoniazid, rifampicin and pyrazinamide for 2 months and pyrazinamide and isoniazid for 7 months. At the end of treatment, the patient showed clear improvement of symptoms and disappearance of uterine intracavitary collection in the ultrasonographic study.

The molecular diagnosis of pelvic tuberculosis: a case report.

Tuberculosis is a re-emerging infectious disease. A retrospective analysis was made of the clinical history of a 48-year-old woman in April 2009; she was a secretary at a third-level hospital living in an urban area. Pelvic tubercular infection was suggested as a possible diagnosis; spoligotyping molecular methodology was used on a peritoneal secretion sample to confirm such diagnosis and confirmed the presence of Mycobacterium tuberculosis (octal code 777777777760771, SIT 53, Family T1).

The molecular diagnosis of pelvic tuberculosis: a case report / Diagnóstico molecular de tuberculosis pélvica: reporte de caso

Tuberculosis is a re-emerging infectious disease. A retrospective analysis was made of the clinical history of a 48-year-old woman in April 2009; she was a secretary at a third-level hospital living in an urban area. Pelvic tubercular infection was suggested as a possible diagnosis; spoligotyping molecular methodology was used on a peritoneal secretion sample to confirm such diagnosis and confirmed the presence of Mycobacterium tuberculosis (octal code 777777777760771, SIT 53, Family T1).

La tuberculosis es una enfermedad infecciosa reemergente. Durante el mes de abril de 2009 se realizó el análisis retrospectivo de la historia clínica de una mujer de 48 años de edad, residente en área urbana, secretaria de un hospital de tercer nivel. Se determinó infección tuberculosa pélvica como diagnóstico presuntivo. Con el fin de confirmar dicho diagnóstico, se realizó la metodología molecular de spoligotyping en muestra de secreción peritoneal y confirmó la presencia de Mycobacterium tuberculosis, código octal 777777777760771, SIT 53, familia T1.

Úlcera genital, nem sempre uma clássica DST: relato de um caso tuberculose vulvar / Genital ulcer, nor always a classic DST: case report of a tuberculosis vulvar

A tuberculose vulvar é uma patologia rara, geralmente associada a um foco primário pulmonar. O objetivo deste relato é apresentar o quadro clínico, diagnóstico e tratamento de um caso de tuberculose vulvar acompanhado no serviço de Ginecologia da Santa Casa de Misericórdia de Vitória em 2004. Relata-se o caso de uma paciente de 54 anos, casada, com uma úlcera genital crônica, de grande extensão, sem outros sintomas associados. Foi submetida a biópsia da lesão e exames para investigação de doenças sexualmente transmissíveis (sífilis, hepatites e HIV). Dos resultados, o estudo histopatológico evidenciou granuloma sugestivo de tuberculose, após descartar outras suspeitas. Realizou-se então como propedêutica radiografia de tórax, o qual apresentou lesões sugestivas de tuberculose. Fez-se baciloscopia do escarro, com resultado positivo. Diante do quadro de tuberculose pulmonar e do resultado encontrado na biópsia da úlcera genital, iniciou-se o tratamento com tuberculostáticos. Obteve-se então confirmação da tuberculose vulvar através da prova terapêutica positiva, com melhora significativa da lesão genital nos primeiros sete dias de tratamento. Observouse a importância de ter a tuberculose como diagnóstico diferencial nas úlceras genitais crônicas, por requerer investigação diagnóstica adequada para se instituir o tratamento preciso e obter a cura.

The tuberculosis to vulvar is a rare pathology, generally associated to a pulmonary primary focus. The objective of this ceport is to present the clinical, diagnostic picture and treatment of a vulvar tuberculosis followied in the service of Gynecology of the Santa Casa de Misericórdia de Vitória in 2004. The case of a patient of 54 years old, married, with a chronic genital ulcer, of great extension, without other symptoms associates. It was submitted the biopsy of the injury and examinations for inquiry of some sexually transmissitted deseases (syphilis, hepatites and HIV). The results the biopsy it evidenced granuloma suggestive of tuberculosis, after to discard others suspicion. It was become fullfilled x-ray of thorax, which presented suggestive injuries of tuberculosis. Baciloscopy of pulmonary secretion became, with positive result. Ahead of the pulmonary picture of tuberculosis and the result found in the biopsy of the genital ulcer, the treatment with tuberculostatics was initiated. Confirmation of the tuberculosis was gotten then to vulvar through positive the therapeutical test, with significant improvement of the genital injury in first the seven days of treatment. It was observed the importance of if having the tuberculosis as diagnostic differential in the chronic genital ulcers, for requiring adequate diagnostic inquiry to do the necessary treatment and getting the cure.

Tuberculosis genital y CA-125 elevado / Genital tuberculosis and high CA-125 titles

Se presenta caso de tuberculosis genital en mujer joven con títulos altos de CA-125 y diagnóstico inicial de carcinomatosis peritoneal de probable origen ovárico. Se compara hallazgos con lo reportado en la literatura a tráves de los 20 años en Medline y se discute su tratamiento

Endometrial pathology and infertility.

OBJECTIVE: To call attention to endometrial pathologies, which in addition to causing menstrual problems, are a cause of infertility. DESIGN: Controlled clinical study. SETTING: Specialized unit in the management of infertile patients. PATIENT(S): Fifteen infertile women between the ages of 26 and 39 years and suffering infertility from endometrial problems for a period of 4 to 18 years were included in the study. Six patients had primary infertility and nine others had secondary infertility. INTERVENTION(S): Once the endometrial pathology was diagnosed, treatment was initiated according to the type of problem: hysteroscopy, curettage, and hormonal replacement with or without corticoids or antiphymic drugs. MAIN OUTCOME MEASURE(S): Clinical studies, laboratory tests, hormonal serum levels, and endoscopy. RESULT(S): After initiating specific treatment for each of the pathologies, menstruation was re-established in 14 of 15 patients. Nine patients became pregnant (8 of 10 cases with bone, squamous cell, or muscular metaplasia). CONCLUSION(S): Pathological changes of the endometrium are causes of infertility. These problems are not as rare as thought. They must be searched for carefully and diagnosed promptly. The majority carry a good prognosis when adequately treated.

Tuberculosis of the female reproductive tract: effect on function.

OBJECTIVE: To discuss the clinical presentation and consequences of genital tuberculosis (GTB), a known cause of infertility. Although it appears to be a rare entity, usually secondary to a primary site of infection by Mycobacterium tuberculosis, its true incidence is not known owing, in part, to inadequate diagnostic procedures, particularly in less developed areas of the world. PATIENTS AND METHODS: We present our experience with 25 cases of genital TB. Of these woman, 21 were seen for infertility; 3 were postmenopausal with uterine hemorrhage, and 1 was admitted with an acute abdomen. All women were treated medically and/or surgically. RESULTS: Only five women were found to be suitable for artificial insemination. Two of the women became pregnant but aborted. CONCLUSIONS: The incidence of genital TB may be higher than one might imagine, based on the lack of reports in the literature, and may account for a significant amount of female infertility.

PIP: During 1988-93, in Mexico City, the National Institute of Perinatology diagnosed 25 cases of female genital tuberculosis. Their age ranged from 21 to 42 years. The diagnostic procedures used to detect these cases included laparoscopy, PPD skin test reaction, hysterosalpingography (HSG), culture of tissue and fluid samples, and histopathological examination of tissue biopsies. 16% had a history of tuberculosis. 39.1% had a history of contact with a relative with tuberculosis. Three women were postmenopausal and suffered from uterine bleeding; they underwent a hysterectomy. 17 of 21 women who went on to infertility studies had suffered infertility for 2-14 years. HSG revealed abnormalities in 95.2%, especially bilateral tubal occlusion (57.1%) and deformity of the uterine cavity (54.5%). Mycobacterium tuberculosis was isolated in 4 women, all of whom had fluid in the pelvic cavity. 14 of the 16 patients who underwent the PPD skin test had an induration larger than 10 mm in diameter. 68% of the 19 patients who underwent endometrial biopsy had granulomas consistent with tuberculosis. All the women received antibiotics to treat female genital tuberculosis. Five of the 17 patients referred for infertility evaluation underwent in vitro fertilization and embryo transfer. Two of these women became pregnant but later suffered a spontaneous abortion. The other 3 women never conceived. These findings indicate that the incidence of female genital tuberculosis may be higher than expected and may be responsible for a substantial amount of female infertility. Pregnancy occurs when female genital tuberculosis is detected at an early stage and when no irreversible anatomical pathology is evident. Thus, it is important to determine the existence of tuberculosis early in cases of infertility and to begin therapy immediately.

Tuberculose genital e amenorréia primária: descriçäo de caso / Primary amenorrhea and tuberculosis: case report

A associaçao de amenorréia primária e tuberculose genital é rara. Nesse relato descreve-se o caso de uma mulher de 16 anos de idade com história de amenorréia primária com presença de caracteres sexuais secundários normais. Por suspeita clínica de anomalia mulleriana foi feito laparotomia exploradora que foi inconclusiva, e o diagnóstico foi direcionado pelo PPD fortemente reator, sendo definido após pela histeroscopia e análise histológica do material endometrial.

Tuberculosis genital femenina

La tb genital casi siempre es secundaria a un foco primario localizado en área pulmonar, renal, intestinal, o peritoneal. Es rara la producida por el bacio tuberculoso bovino originado por la ingestión de leche contaminada. La vía de diseminación es la hemática en el 90 por ciento de casos iniciandose en el endosalpinx la misma que casi siempre es asintomática, es de descubrimiento causal al realizar un protocolo de esterilidad. El examen físico y el chequeo ginecológico no es concluyente a excepción de la Tb avanzada en donde se puede palpar masas abdominales difusas o con presencia de ascitis.