Title: Rare presentation of Genital tuberculosis in young female as Primary amenorrhea with pyocolpos
Genital tuberculosis is the most mysterious form of Extrapulmonary tuberculosis represents 15-20% of EPTB. The spread is generally through haematogenous or lymphatic routes.
14 year old female presented with severe pain in lower abdomen in outpatient department of our hospital .Pain was insidious in onset and aggravated one week back . History revealed she had primary amenorrhea .There is no history of fever, weight loss, night sweats of loss of appetite, weight loss bowel and bladder complaints. In family, father had history of pulmonary Tuberculosis. On examination general condition fair , thin built with BMI 16kg/m2. ,breast examination with axillary and pubic hair were Tanner stage 3 .Abdomen was soft and there was no distension. A pelvic mass of 20 weeks size midline cystic with restricted mobility was present in pelvis. Vulval inspection revealed . Per vaginum -thick hymenal ring present .Per rectal examination revealed bulging of posterior vaginal wall into the rectum. USG showed vagina appears distended with fluid containing fine internal echoes collection measuring 15.8x8.8x10.6 cm approximately. Uterus is pushed up and is seen lying at the level of umbilicus and bilateral adnexa and ovaries are normal. Fluid containing fine echoes is seen distending vaginal cavity s/o hydrocolpos. Routine investigations were normal limits. The girl was planned for drainage in view of ? Imperforate hymen with hydrocolpos .Under anaesthesia when a small incision was given over the intact hymen. About 700ml -800 ml pus drained out. It was sent for gram staining, AFB smear-culture and CBNAAT. Foleys catheter was placed in vagina. Soframycin applied locally . Z-N stain of the pus showed plenty of Acid Fast Bacilli. CBNAAT showed tubercle bacilli. Antitubercular therapy with intensive phase 4-drugs started and follow-up is continuing.This case is unique and interesting because the age of presentation makes and the clinical picture was such that one will be tempted to diagnose as hematocolpos leading to primary amenorrhea.
Dr Deepika working as Assistant professor in department of obstetrics and gynaecology AIIMS Bathinda India.She has over 12 publications in national and international journals. She is Associate member of Royal college of Obstetrics and Gynaecology .She is member of reputed societies AICOG, AOGD and MNAMS.