Genital tract tuberculosis with myometrial involvement

International

Journal

of Gynecology

& Obstetrics

57 (1997)

191-192

Brief communication

Genital tract tuberculosis with myometrial involvement R. Sinha*, D. Gupta, N. Tuli Depamnt Received

Keywords:

Genital

tract;

of Gynecology 1 October

Tuberculosis;

and Obstetrics,

1996; revised

Safdarjung

29 January

0020-7292/97/$17.00 PII SOO20-7292(97)

author,

723 Laxmibai

Q 1997 International 02877-4

1997; accepted

New Delhi, India 3 February

1997

Myometrium

Despite its contiguity with endometrium, myometrium is seldom involved in patients with genital tuberculosis El]. Here, we describe a case of myometrial tuberculosis and its sonographic findings. A 37-year-old woman, para 2, complained of menorrhagia for the past 6 months. She had regular menstrual cycles of 6/28 days. There was no history of abdomen pain, vaginal discharge, bleeding disorders, cough, hemoptysis, fever, night sweats or weight loss. Her general physical and systemic examination were unremarkable. Cervix, uterus and adnexa were normal on genital examination. Her hemoglobin was 10 g%, total and differential leukocyte counts were within normal limits. Erythrocyte sedimentation rate was 45 mm 1st hour (Wintrobe). Urine microscopic examination and culture were normal. Transvaginal ultra-

*Corresponding 110023, India.

Hospital,

Nagar,

New

Federation

Delhi

of Gynecology

sound showed a normal sized uterus with endometrial thickness of 10 mm (premenstrual phase). There were multiple anechoic areas of variable size with well-defined borders scattered throughout the myometrium (Fig. 1). The finding was suggestive of multiple seedling fibroids. Both ovaries were normal. Histopathological examination of endometrial curettings obtained by premenstrual dilatation and curettage revealed well-formed epitheliod granulomas. Her X-ray of the chest and sputum examination were normal. However, a Montoux test was positive (induration of 20 X 20 mm). A diagnosis of endometrial tuberculosis with fibroid uterus was made and the patient was put on anti-tubercular treatment with rifampicin 450 mg/day, isoniazid 300 mg/day, pyrazinamide 1.5 g/day and ethambutol 800 mg/day for 2 months followed by rifampicin and isoniazid for the next 4 months. The patient was relieved of menorrhagia after 4 months. Endometrial biopsy taken and Obstetrics

192

R Sinha et al. /International Journal of Gynecology & Obstetrics 57 (1997) 191-192

Fig. 1. Transvaginal sonogram showing multiple anechoic areas scattered throughout the myometrium.

after completion of treatment showed normal secretory endometrium with no evidence of granuloma. Repeat transvaginal sonogram showed a homogenous myometrium with no evidence of anechoic areas. Although microscopic involvement of myometrium is observed in 20% of cases ofendometrial tuberculosis 121, gross involvement of myometrium is not common. The mechanism of resistance of myometrium to tuberculosis is not well known. Tubercular involvement of adenomysosis has been proposed as a possible mechanism [3]. In the presented case, clinical history and ultrasound findings were unlike those observed in adenomyosis (ill defined anechoic areas in the inner myometrium) [4]. No definite ultrasonographic findings of myometrial tuberculosis have been reported to date. Thus, in view of

endometrial tuberculosis and multiple anechoic areas on sonographic examination which resolved after antitubercular treatment, a diagnosis of endometrial tuberculosis with myometrial involvement was made.

References

[l]

Schaefer G. Female genital tuberculosis. Chn Obstet Gynecol 1976; 19: 223-239. [2] Nogales-Ortiz F, Tarancon I, Nogales FF Jr. The pathology of female genital tuberculosis - a 31 year study of 1436 cases. Obstet Gynecol 1979; 53: 422-428. [3] Rozum VM. Tuberculosis in adenomyosis of the uterine body. Akush Ginekol Mosk 1985; 7: 64-65. 141 Grunfeld L. The uterus and endometrium. Clin Obstet Gynecol 1996; 39: 175-187.