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1/76. Genital tuberculosis with peritonitis mimicking Meigs' syndrome: a case report.

    A 19-year-old girl presented with genital tuberculosis (TB) complicated with peritonitis and pleural effusion. In addition to oligomenorrhea, her initial presentation included symptoms of intermittent high fever, exertional dyspnea, productive cough and body weight loss. Acid-fast bacilli were identified by sputum culture. She continued to suffer from persistent abdominal discomfort and body weight loss after eight months of anti-TB treatment. Finally, exploratory laparotomy was performed under the suspicion of Meigs' syndrome or TB peritonitis. Operative findings included diffusely granulomatous change over the peritoneum, ovaries, endometrium, intestine and liver. Histologic examination of the ovaries and endometrium showed caseous necrosis associated with Langhan's giant cells and epithelial cells. Acid-fast stain revealed numerous acid-fast bacilli. She was discharged after two months of anti-TB treatment. Anti-TB therapy was continued for one year after discharge. During 3 years of post-discharge follow up, she was free of abdominal discomfort and had given birth to two healthy children. ( info)

2/76. Tuberculosis of the vulva masquerading as a sexually transmitted disease.

    Tuberculosis of the vulva is a rare condition usually seen by a gynecologist. We report a case of chronic ulcer on the vulva of four months duration, which, on detailed investigation, turned out to be a case of primary inoculation tuberculosis. The patient was subsequently put on antitubercular therapy with a good the therapeutic response. The rarity of this presentation in dermato-venereology is emphasized. ( info)

3/76. diagnosis of culture-negative female genital tract tuberculosis with peritoneal involvement by polymerase chain reaction.

    BACKGROUND: female genital tract tuberculosis (TB) is a common cause of infertility in developing countries. It is a paucibacillary form of the disease of which smears and cultures are usually negative. CASE: We were able to use polymerase chain reaction (PCR) amplification of mycobacterium tuberculosis dna to support a clinical and histologic diagnosis of a typical case of culture negative female genital tract TB. CONCLUSION: PCR may be a useful adjunct to diagnostic efforts in gynecologic tuberculosis. ( info)

4/76. Juvenile fulminant adnexal tuberculosis caused by gastrointestinal tuberculosis immediately after ovarian cystectomy.

    Genital fulminant tuberculosis is rarely a primary site of infection. We report a case of juvenile adnexal tuberculosis possibly related to tuberculosis immediately after cystectomy in the ileocecal region in a virginal girl. A 13-year-old virginal girl visited our clinic because of a huge ovarian tumor, which was resected by cystectomy. On postoperative day 39, fever episodes were noted, and she received antibiotics, which were not effective. An abscess developed in the region of the cecum and the right adnexa. laparotomy revealed chronic abscess formation, especially in the right adnexa. Resection of the abscess was done. The pathological diagnosis was tuberculosis with caseation, although bacterial culture and molecular biological diagnosis for mycobacterium tuberculosis were negative in sputum, vaginal discharge, urine, and stool of the patient and her family. She was placed on anti-tuberculosis drugs, including isoniazid, rifampicin, and ethambutol, and this regimen was effective. This patient represents a rare case of fulminant adnexal tuberculosis without pulmonary disease. ( info)

5/76. Tuberculosis of the cervix: case presentation and a review of the literature.

    Cervical tuberculosis is uncommon in the developed world. We describe a patient who attended a genitourinary medicine clinic, and who was found to have cervical tuberculosis, in association with hiv infection. ( info)

6/76. Case report: abdominal cocoon associated with tuberculous pelvic inflammatory disease.

    Abdominal cocoon is a rare acquired condition in which there is encapsulation of the small bowel by a fibrous membrane. The authors describe a case wherein an organism was identified for the first time. The clinical, pathological and radiological features of this unusual disease are reviewed. Peritoneal encapsulation, a related subject, is also discussed. ( info)

7/76. Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis.

    A 48-yr-old female presented with a 1-yr history of pain in the hypochondrium and epigastrium. All routine investigations and computed tomography (CT) of the abdomen were done. CT findings revealed a well-defined cystic mass in the right ovary, and ascitis with features suggestive of secondaries over the omentum and peritoneal surface. The serum CA125 was 1255 U/mL (normal range 0-35 U/mL), which was indicative of ovarian malignancy. An exploratory laparotomy was performed. Histopathological examination of organs revealed the presence of granuloma. The patient was advised to undergo antitubercular treatment (ATT) and follow-up every month. After 1 mo of ATT, the CA125 level came down to 42 U/mL, which was near normal. As tuberculosis requires only a conservative management, we suggest that in cases of abdominopelvic mass with or without ascitis, high serum CA125 should always raise a suspicion of tuberculosis and a laparoscopy combined with peritoneal biopsy should be performed to confirm the diagnosis. This will prevent unnecessary laparotomies. Moreover, serum CA125 can be used to monitor the response of disease to antitubercular treatment. ( info)

8/76. Primary endometrioid adenocarcinoma with coexisting endometrial tuberculosis. A case report.

    BACKGROUND: The most important cause of postmenopausal bleeding is endometrial cancer, whereas genital tuberculosis is uncommon in this age group. The association of these two disorders is extremely rare. CASE: Endometrial curettings performed on a 63-year-old woman with a bloody vaginal discharge and thickened endometrium disclosed complex atypical hyperplasia and granulomatous inflammation with caseation necrosis. The uterus contained a well-differentiated endometrial adenocarcinoma with squamous differentiation invading about one-half the myometrial thickness and granulomatous inflammation with caseation necrosis. The lymph nodes were free of disease. CONCLUSION: Although the coexistence of endometrial cancer and tuberculosis is extremely rare, it may occur in patients who live in the regions with a high prevalence of tuberculosis. ( info)

9/76. Genital elephantiasis.

    Genital elephantiasis (esthiomene), which is the dramatic end-result of lymphatic obstruction, is rather rare. Although mainly associated with filariasis and sexually transmitted diseases, such as lymphogranuloma venereum and donovanosis, it could also be an uncommon complication of tubercular lymphadenitis, a common infection in tropical countries. We report a rare case of a 32-year-old Indian female in whom genital elephantiasis occurred as a complication of tubercular lymphadenitis. ( info)

10/76. Recent changes in the assessment of urogenital tuberculosis.

    The urogenital tuberculosis has undergone a change in form and clinical assessment. The absolute proportion of urogenital tuberculosis cases has fallen off sharply since 1967. The nmber of surgical interventions is also remarkably reduced. The cases exhibiting a milder stage have significantly increased, while the severe cases have decreased. This change of tuberculosis has made a conservative therapy favorable; therefore the current operative indication is somewhat different than 15 years ago. The time of release from the stationary treatment depends first on the animal experiment and bacterial findings; furthermore, tests are necessary to determine the status of immunity. It was revealed with urogenital tuberculosis, through regular examination of the menstrual blood of women, that the number of positive cases among women was considerably higher, than among men. In contracted bladder a surgical intervention is often necessary due to intense pain and incontinence. We prefer the rectal bladder with sigmoid pull-through inside the sphincter ani, whereby excellent success can be achieved. The study shows that the clinical assessment of tuberculosis is somewhat different today than is was earlier. Tuberculosis underwent a change in form that must be taken into consideration with respect to operative indication. ( info)
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