Tuberculous endometritis - a worrying recrudescence for infertility

Authors:Kajal B Punyashetty, Anand A S, Trupti Vyasrao Katti
Int J Biol Med Res. 2012; 3(2): 1708- 1711  |  PDF File

Abstract

Aim: i) To determine tuberculous endometritis as an etiological factor in primary and secondary infertility. ii) To study age incidence and clinical presentation of cases with tuberculous endometritis. Method: Prospective study of 5years was conducted from 2005- 2010, at department of pathology, M R Medical College, Gulbarga, Karnataka. Endometrial curettings received from 230 cases of primary and secondary infertility were included. The diagnosis of endometrial tuberculosis was made on histological grounds with H&E stained slides, Z-N staining for Acid Fast Bacillus (AFB) positivity and culture of AFB on Lowenstein Jensenís medium. Results: Seven cases of tuberculous endometritis were diagnosed from 230 cases presenting with infertility and accounted to 3.9 % of cases. All these patients belong to primary infertility group, with majority in the age group of 17-25 years (71.5 %). Clinically, five cases (71%) presented with history of secondary amenorrhoea and two cases (28%) with irregular menstrual pattern. On histopathology, all cases were diagnosed as tuberculous endometritis, in which five cases showed epithelioid granulomas with Langhanís giant cells and two cases showed caseation only. These 7 cases, when subjected to modified Zeihl Neelsenís stain, two cases (28.5 %) showed AFB positivity and when allowed to culture on Lowenstein Jensenís medium, four cases (57%) were positive. Conclusion: Therefore, clinicians need to have an in depth knowledge of pathology, be aware that isolation of Tuberculosis requires special methods, especially while dealing with patients dwelling in countries with high prevalence of Tuberculosis in infertility and the diagnostic means with which to discover it early and correct therapeutic modalities, to over come.