Female genital tuberculosis and infertility: serial cases report in Bandung, Indonesia and literature review

Abstract

Background: Female genital tuberculosis (FGTB) is a Mycobacterium infection in the reproductive organs which often leads to infertility. FGTB is either asymptomatic or causes uncharacteristic clinical presentations, making an early diagnosis is challenging. Our aims were to evaluate the clinical presentations, the process to confirm the diagnosis and followed-up the patients who had undergone laparoscopy at our center. FGTB has been reported from many countries, but has never been reported from Indonesia. Here we present case studies to document the presence of FGTB in Indonesia.

Cases presentation: There were three patients admitted to our center; two patients were admitted with irregular menstrual cycle as their chief complaint, while one patient came due to infertility. The results from laparoscopy were suggestive of FGTB; including the presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells, and Langhans giant cells. Additionally, PCR testing confirmed presence of MTB. Subsequent to diagnosis, continuous TB medications was administered with excellent clinical outcome in two patients (pregnant in 18 months after under gone laparoscopy). The infertile patient remain in one of the treated patient above.

Conclusion: In infertile patients who live in countries where Tuberculosis is an endemic disease, such as Indonesia, a comprehensive history taking, along with ultrasonography results can be used to diagnose FGTB. Confirmation of this diagnosis can be achieved through polymerase chain reactions result. Timely diagnosis and treatment are imperative to prevent any permanent injury to patient's reproductive organs.

Keywords: Female genital tuberculosis; Histopathology examination; Infertility; Laparoscopy; Polymerase chain reaction; Serial cases report.

Fig. 1

In case 1 the results showed there are tubercles with presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells and giant cells (magnification 100× and 400×)

Fig. 2

In case 2 the final histopathology finding revealed TB infection that shown as the accumulation of the epitheloid granulomas, datia Langhans cells, and caseous necrosis (magnification 100× and 400×)

Fig. 3

In case 3 photomicrograph showing tuberculous granulomas in the mucosa layer of fallopian tube and fused plica (magnification 100× and 400×)

Fig. 4

Polymerase chain reaction (PCR) results. The IS6110 primers amplify a fragment of Mycobacterium TB with a length of 123 base pair (bp)