CASE REPORT
KEYWORDS
Tuberculosis;
Cervical smear;
Colposcopy;
Tubercuolous cervicitis
Abstract Background: Primary Tuberculosis of the uterine cervix is an unusual event, with only a
few cases reported in the English literature.
Case report: A 25 year old nulligravid woman was referred to our hospital with suspected
cervical carcinoma. General, gynecologic, colposcopic and microbiologic assessments were done.
Diagnosis of cervical tuberculosis was conrmed on histologic examination. The patient received
anti-tuberculous therapy and has been disease free for 12 months.
Conclusion: Cervical tuberculosis may mimic cervical carcinoma and should be included in the
differential diagnosis especially in endemic countries.
2013 Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.
1. Introduction
Tuberculous infection (TB), which is now uncommon in Western society, is still frequently observed in Third World countries in Africa and Asia. The cervix is involved in 0.10.65%
of all cases of tuberculosis and 510% of cases in female genital tract. Tuberculous involvement of the female genital tract
in almost all cases is secondary to extragenital tuberculosis.
Affectation of the female genitalia has been reported as a rare
event (1). TB is usually secondary to a primary focus elsewhere
in the body most commonly from lungs. Spread to cervix is
* Corresponding author. Tel.: +20 1222854159.
E-mail addresses: emyelkattan@gmail.com (E. Elkattan), monanayel
2010@hotmail.com
(M. AbdElBadei), hiae09@yahoo.com
(H. Hettow), emanalyhussein@yahoo.com (E. Hussein).
Peer review under responsibility of Middle East Fertility Society.
1110-5690 2013 Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.
http://dx.doi.org/10.1016/j.mefs.2013.05.005
Please cite this article in press as: Elkattan E et al. Tuberculous cervicitis mimicking cancer cervix: A case study, Middle East
Fertil Soc J (2013), http://dx.doi.org/10.1016/j.mefs.2013.05.005
E. Elkattan et al.
analysis were negative. Tuberculin skin test was not done.
The patient was referred to the department of chest diseases.
Antituberculous medications were prescribed in the form of
isoniazid (5 mg/kg), Rifampicin (10 mg/kg), Pyrazinamide
(25 mg/Kg) and ethambutol (15 mg/kg). The treatment continued for 6 months.
Her cervical smear follow ups were negative up to 1 year
following treatment. There was no history of postcoital bleeding after the cone biopsy. Unfortunately, we did not have bacterial evidence on the cone biopsy but as tuberculosis was
suggested by the pathologist and the fact that the patient improved on antituberculous treatment made it more likely that
it is tuberculosis. A signed consent form from the patient had
been obtained.
2.1. Discussion
In 2011, 8.7 million people fell ill with TB and 1.4 million died
from TB. The Incidence of tuberculosis (per 100,000 people) in
Egypt was last reported as 19 in 2011, according to a World
Bank report published in 2012 (4). The incidence of TB has
been increased recently especially in areas where HIV and
TB are prevalent (5).
Genitourinary tuberculosis (TB) is more prevalent in developing countries. Fallopian tubes and ovaries are commonly involved. Rarely, other pelvic organs like the vagina, vulva,
myometrium and cervix may be involved. Cervical TB accounts for 0.10.65% of all cases of TB and 524% of genital
tract TB (6). In rare cases, cervical TB may be a primary infection introduced from a partner with tuberculous epididymitis
or other genitourinary diseases (7). Sputum used, as a sexual
lubricant may also be a mode of transmission of genitourinary
tuberculosis (1). Cervix is relatively resistant to tuberculosis
infection because the stratied squamous epithelium of the
ectocervix prevents bacterial penetration. In addition, cervical
mucus is known to have antibacterial action.
50% of patients remain asymptomatic. Symptomatic genital tract TB usually presents with abnormal vaginal bleeding,
menstrual irregularities, abdominal pain, and constitutional
symptoms (3,8). The diagnosis of cervical TB is usually made
by histological examination of a cervical biopsy specimen.
Staining for acid-fast bacilli may not be very useful in making
a diagnosis (9). Although isolation of mycobacterium is the
gold standard for diagnosis, one third of cases are culture negative, therefore the presence of typical granulomata is sufcient for diagnosis if other causes of granulomatous cervicitis
are excluded. New modalities and diagnostic tests could be
considered such as Serodiagnosis by enzyme linked immunosorbent assay (ELISA), which increases the detection rate
(10). PCR (Polymerase chain reaction) technique is also one
of the recent advances for rapid detection of tuberculosis
(11). Surgery is rarely indicated, usually in drug resistant cases.
A case similar to present case, which had been confused with
cervical malignancy, has been reported (8,12).
2.2. Educational message
The possibility of Tuberculous cervicitis should be kept in
mind in the differential diagnosis of suspicious cervix especially in areas where Tuberculosis is prevalent, taking into consideration the difculty in the diagnosis of genital tuberculosis.
Please cite this article in press as: Elkattan E et al. Tuberculous cervicitis mimicking cancer cervix: A case study, Middle East
Fertil Soc J (2013), http://dx.doi.org/10.1016/j.mefs.2013.05.005
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(7) Jaiprakash P, Pai K, Rao L. Diagnosis of tuberculous cervicitis by
Papanicolaou-stained smear. Ann Saudi Med 2013;33(1):768.
(8) Singh S, Gupta V, Modi S, Rana P, Duhan A, Sen R.
Tuberculosis of uterine cervix: a report of two cases with variable
clinical presentation. Trop Doct 2010:401256.
(9) Kalyani R, Sheela S, Rajini M. Cytological diagnosis of tuberculous cervicitis: a case report with review of literature. J Cytol
2012;29(1):868.
(10) Shin AR, Shin SJ, Lee KS, Eom SH, Lee SS, Lee BS, Lee JS, Cho
SN, Kim HJ. Improved sensitivity of diagnosis of tuberculosis in
patients in Korea via a cocktail enzyme-linked immunosorbent
assay containing the abundantly expressed antigens of the K
strain of Mycobacterium tuberculosis. Clin Vaccine Immunol
2008;15(12):178895.
(11) Honore-Bouakline S, Vincensini JP, Giacuzzo V, Lagrange PH,
Herrmann JLJ. Rapid diagnosis of extrapulmonary tuberculosis
by PCR: impact of sample preparation and DNA extraction. Clin
Microbiol 2003;41(6):23239.
(12) Agarwal S, Madan M, Leekha N, Raghunandan C. A rare case of
cervical tuberculosis simulating carcinoma of cervix: a case
report. Cases J 2009;2:161.
Please cite this article in press as: Elkattan E et al. Tuberculous cervicitis mimicking cancer cervix: A case study, Middle East
Fertil Soc J (2013), http://dx.doi.org/10.1016/j.mefs.2013.05.005