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An Infertile Patient

, Chandrachur Konar , Roshini P. , Rajiv Kumar Saxena

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Indian Journal of Obstetrics and Gynecology 5(3 (Supplement)):p 291-291, Jul-Sep 2017. | DOI:

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Abstract

Background: Although the relation between genital tuberculosis (GTB) and infertility has been well established, but for the asymptomatic patient, the diagnosis requires a very high index of suspicion. Though GTB is always secondary to primary foci, CA 125 value, Adenosine deaminase levels (ADA), biopsies, curettings or aspirate for histopathological examinations for granulomatous lesions and also AFB smear and culture or BACTEC systems are necessary for accurate diagnosis. We report here a case of a patient with 6 years infertility that was diagnosed to have genital tuberculosis following a laparotomy for a pelvic mass. Case Report: 23 years-old nulligravida, with six years of infertility, came with complains of six weeks of amenorrhoea associated with abdominal pain and guarding with vaginal spotting. There was no abdominal distension or palpable mass. Her urine pregnancy test was negative. Ultrasound reported a right adnexal dermoid cyst measuring 6x6 cm with suspected torsion. There was another cystic lesion in right adnexa measuring 7x5x3cm suggestive of pyosalpinx. She underwent emergency laparotomy with right ovarian Cystectomy and right salpingectomy. Adhesiolysis of flimsy adhesions in POD was also done. The cyst contained hair and sebaceous material. Presence of adhesions and pyosalpinx, seemed unrelated to torsion of ovarian cyst, and raised the suspicion of pathology. Hence, check curettage was done and samples were sent for histopathology (HPE) and TB PCR. Postoperative recovery was uneventful. Her chest radiograph was clear and mountex test was also negative. However, HPE and TB PCR confirmed our suspicion of GTB. She was started on Category 1antitubercular treatment. Conclusion: Genital TB affects about 12% of patients with pulmonary tuberculosis and represents 15–20% of extrapulmonary tuberculosis. Genital TB may be asymptomatic or may masquerade as other gynaecological conditions. Diagnosis requires a high index of suspicion. 

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