Cervical tuberculosis in a postmenopausal patient

Czech version

Authors: Prokešová N. ¹; Valha P. ¹; Velemínský M. ¹; Vítková P. ²; Stehlíková A. ²
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice České Budějovice, a. s. ¹; Patologické oddělení, Nemocnice České Budějovice, a. s. ²
Published in: Ceska Gynekol 2021; 86(6): 392-396
Category: Case Report
doi: https://doi.org/10.48095/cccg2021392

Overview

Objective: Description of a case of extrapulmonary genital tuberculosis of the uterine cervix in a postmenopausal patient. Case report: A 66-year-old patient with a history of metrorrhagia, an ulcerated process in the area of the uterine cervix and vagina, with infiltration of parametria, serosanguinolent discharge and progressive cachectization was admitted to the oncogynecological center of the Hospital of České Budějovice, a. s. As part of the diagnostics, physical examination, colposcopy, targeted biopsy, polymerase chain reaction (PCR) and microbiological examination, oncogynecological ultrasound and CT examination were performed. Clinically, the lesion acted as an advanced tumor. However, no malignant cells were detected in the biopsy and the histopathological finding corresponded to a granulomatous inflammatory condition with giant cell histiocytic elements. Bacterial DNA of Mycobacterium tuberculosis complex was detected by PCR testing. The patient underwent controlled antituberculosis treatment with regular gynecological examinations. Conclusion: Tuberculosis of the uterine cervix occurs rarely. Its clinical manifestation may mimic the tumor process. Diagnosis is based on the identification of the causative agent and treatment consists of long-term controlled administration of antituberculotics, and in rare cases, combination with surgical treatment.

Keywords:

extrapulmonar tuberculosis – genital tuberculosis – uterine cervix – Mycobacterium tuberculosis complex

Sources

1. ÚZIS ČR. Základní přehled epidemiologické situace ve výskytu tuberkulózy v ČR v roce 2019. 2021 [online]. Dostupné z: https: //www.uzis.cz/index.php?pg=record&id=8314.

2. Weinberger V, Dvořák M, Haaková L et al. Ultrazvukový staging karcinomu děložního hrdla – návrh standardního postupu. Ceska Gynekol 2014; 79 (6): 447–455.

3. Ndour MA, Sow M, Thiam I et al. Pseudotumoral tuberculosis of the cervix. Pan Afr Med J 2019; 32: 163. doi: 10.11604/pamj.2019.32.163.17763.

4. Češka R, Štulc T, Tesař V et al. Interna. 3. vyd. Praha: Stanislav Juhaňák – Triton 2020: 524–528.

5. MZČR. Metodika očkování proti TBC v ČR. Ministerstvo zdravotnictví. 2012 [online]. Dostupné z: https: //www.mzcr.cz/metodika- ockovani-proti-tbc-v-cr/.

6. Gupta A, Gupta MM, Mankatala U et al. Primary tuberculosis of cervix mimicking carcinoma: a rare case. J Midlife Health 2014; 5 (2): 95–97. doi: 10.4103/0976-7800.133999.

7. Kumari R, Vaishya V, Khanna G et al. Tuberculosis of the cervix: an uncommon cause of vaginal discharge in a post-menopausal woman. Natl Med J India 2018; 31 (3): 149–150. doi: 10.4103/0970-258X.255757.

8. Sabita S, Sharmila V, Arun Babu T et al. A rare case of cervical tuberculosis which simulated carcinoma of the cervix. J Clin Diagn Res 2013; 7 (6): 1189–1190. doi: 10.7860/JCDR/2013/5460.3077.

9. Sachan R, Patel ML, Gupta P et al. Genital tuberculosis with variable presentation: a series of three cases. BMJ Case Rep 2012; 2012: bcr2012006665. doi: 10.1136/bcr-2012-006665.

10. Macháčková H, Pilka R, Losse S et al. Případ peritoneální tuberkulózy: diagnostika pomocí PET/CT a laparoskopie. Ceska Gynekol 2017; 82 (4): 300–307.

11. Crump JA, Morrissey AB, Ramadhani HO et al. Controlled comparison of BacT/Alert MB system, manual Myco/F lytic procedure, and isolator 10 system for diagnosis of Mycobacterium tuberculosis Bacteremia. J Clin Microbiol 2011; 49 (8): 3054–3057. doi: 10.1128/JCM.01035-11.

12. Rodrigues C, Shenai S, Sadani M et al. Evaluation of the bactec MGIT 960 TB system for recovery and identification of Mycobacterium tuberculosis complex in a high through put tertiary care centre. Indian J Med Microbiol 2009; 27 (3): 217–221. doi: 10.4103/0255-0857.53203.

13. Chen G, Wang H, Wang Y. Clinical application of QuantiFERON-TB Gold in-tube in the diag- nosis and treatment of tuberculosis. Eur J Clin Microbiol Infect Dis 2020; 39 (4): 607–612. doi: 10.1007/s10096-019-03768-9.

14. MZČR. Seznam států TBC – aktualizace únor 2020. Ministerstvo zdravotnictví. 2020 [online]. Dostupné z: https: //www.mzcr.cz/sez- nam-statu-tbc-aktualizace-unor-2020/.

15. Agrawal S, Madan M, Leekha N et al. A rare case of cervical tuberculosis simulating carcinoma cervix: a case report. Cases J 2009; 2: 161. doi: 10.1186/1757-1626-2-161.

16. Singh N, Sumana G, Mittal S. Genital tuberculosis: a leading cause for infertility in women seeking assisted conception in North India. Arch Gynecol Obstet 2008; 278 (4): 325–327. doi: 10.1007/s00404-008-0590-y.

17. Kos S, Vašáková M. Tuberkulóza dospělých – Standard léčebného plánu. Česká pneumologická a ftizeologická společnost ČLS JEP. [online]. Dostupné z: http: //www.pneumologie.cz/upload/1583105755.5311.pdf.