Genital Tuberculosis – An Uncommon Presentation

A married women of 30 years, mother of one child, housewife was referred to out patient department of Khulna Medical College Hospital with history of blood stained vaginal discharge, secondary amenorrhoea for 3 years and evening rise of temperature and anorexia for 3 months. On speculum examination, cervix was oedematous, bright red in colour with papillary growth which bleeds on touch. She also had bilateral excavated lesion at the lowest part of the vagina close to the introitus which was red in colour with undermined edge. Visual inspection aided by acetic acid (VIA) was positive. Colposcopy guided biopsy was taken from unhealthy areas. There was extensive mottling on chest X-ary. She had high ESR, AFB+ve on sputum culture. The patient was diagnosed as a case of active pulmonary TB. Histopathological report of cervical tissue showed granulomatous lesion. Patient was given a regimen of standard anti TB drugs. After 2 weeks, during her first follow up, patient had few symptoms with regression of cervical growth and disappearance of vaginal ulcer. Patient herself stated about her wellbeing after the start of anti- TB drugs. Though cervical TB is not uncommon among genital TB (5-24%), vaginal tubercular lesion is very uncommon and concurrent pulmonary, endometrial, cervical and vaginal tuberculosis is a rare event. Careful evaluation is needed to diagnose tubercular infection in genital organs specially in GOPDs and colposcopy clinics.