ISSN: 2469-6706  Vol. 5   2018 



Chronic Uterine Dehiscence Secondary to
Genitourinary Tuberculosis: A Case Report

Kasey Roberts a , 1 Britta Buchenroth a Joseph Novi a

aRiverside Methodist Hospital, Department of Obstetrics and Gynecology, 3535 Olentangy River Road, Columbus Ohio 43214

Genitourinary tuberculosis (GU TB) most commonly presents as
infertility, pelvic pain, or menstrual irregularities in patients from
countries where the disease continues to be endemic. Case:
A 27 year-old G1P1001 from western Asia presented to our in-
stitution´s urogynecology office for management of pelvic pain
secondary to known uterine dehiscence. The patient underwent
a laparotomy for repair of the dehiscence. During the procedure
she was noted to have a large, white mass within the uterine
dehiscence that was later determined to likely be GU TB. The pa-
tient was referred to the Health Department where she received
one year of anti-TB treatment. Conclusion: GU TB should be
considered in the differential diagnosis of uterine dehiscence in
patients from countries where the disease remains endemic.

genitourinary | tuberculosis | uterine dehiscence

Tuberculosis (TB) presents as genitourinary (GU) TB in 1 to 2%of cases, making it the second most common form of extra-
pulmonary TB (1−3). GU TB can present in multiple ways. One
study examining the presenting complaints of 44 Sudanese women
with pelvic TB found that 80% of affected women complained
of chronic pelvic and lower abdominal pain, 48% of dyspareunia,
40% of infertility, 28% of menstrual dysfunction, and 20% of dys-
menorrhea (1). Additionally, GU TB has been known to act as a
”mimicker” of ovarian or even cervical cancer (3−5). Interestingly,
only 20−30% of patients with GU TB have a history of a pulmonary
TB infection (6). We report a case of pelvic pain caused by uterine
dehiscence secondary to a pelvic tuberculoma in a patient with no
known history of TB.

Case report

Patient information. Age: 27, gender: female, ethnicity: West
Asian, related medical problems: pelvic pain, fatigue, menorrhagia.

Objective for case reporting. Genitourinary TB should be con-
sidered in the differential diagnosis of pelvic pain or masses in pa-
tients from countries where the disease remains endemic.

Introduction. Tuberculosis (TB) presents as genitourinary (GU)
TB in 1−2% of cases, making it the second most common form
of extra-pulmonary TB (1−3). GU TB can present in multiple
ways. One study examining the presenting complaints of 44 Su-
danese women with pelvic TB found that 80% of affected women
complained of chronic pelvic and lower abdominal pain, 48% of
dyspareunia, 40% of infertility, 28% of menstrual dysfunction, and
20% of dysmenorrhea (1). Additionally, GU TB has been known
to act as a ”mimicker” of ovarian or even cervical cancer (3−5).
Interestingly, only 20−30% of patients with GU TB have a history
of a pulmonary TB infection (6). We report a case of pelvic pain
caused by uterine dehiscence secondary to a pelvic tuberculoma in

a patient with no known history of TB.

Case. A 27 year-old G1P1 with a history significant for an
emergent cesarean section (CS) in western Asia presented to our
institution´s urogynecology office for evaluation and management
of a known uterine dehiscence causing sharp lower abdominal
pain/burning, fatigue, and menorrhagia. Imaging obtained prior to
consultation included a pelvic ultrasound (US) and a pelvic mag-
netic resonance image, both of which noted a 2 x 3 x 5 cm midline
mass protruding from a uterine dehiscence (Figure 1, Figure 2; Con-
sent to publish these images was obtained from the patient). Of note,
her CS had been complicated by postoperative wound infection, but
no details of her wound infection were able to be obtained.

Figure 1. Pelvic Ultrasound Demonstrating Tuberculoma in a Uter-
ine Dehiscence.

Given the patient´s symptoms and imaging findings, the deci-
sion was made to proceed with a laparotomy for repair of the uterine
dehiscence. Laparotomy was selected as the route of surgery due to
surgeon preference. At the time of her exploratory laparotomy, the
patient was noted to have clubbing of the distal ends of bilateral

All authors contributed to this paper. 1To whom correspondence should be sent:
kasey.m.roberts@gmail.com

The authors declare no conflict of interest. Submitted: June/19/2018, published: Au-
gust/25//2018.

Freely available online through the UTJMS open access option

12–13 UTJMS 2018 Vol. 5 utdc.utoledo.edu/Translation



fallopian tubes as well as dense adhesions between the omentum,
small bowel, anterior uterine wall, and bladder. Additionally, an
8 x 5 x 4 cm white, spongy-appearing, self-contained mass was
noted to be protruding from the chronic uterine dehiscence. The
mass was excised and was sent for final pathology, which ultimately
demonstrated ” tissue showing extensive areas of necrosis with sur-
rounding associated acute, chronic, and granulomatous inflamma-
tion. Rare acid fast bacilli (AFB) identified within necrotic areas of
AFB stain. (The exact subtype of acid fast bacilli cannot be further
classified by AFB stain). No fungal organisms are identified on the
Grocott´s Methenamine Silver (GMS) stain.”

Figure 2. Pelvic Magnetic Resonance Imaging Demonstrating Tu-
berculoma in a Uterine Dehiscence.

Because of this report, the Infectious Diseases (ID) team was
consulted and recommended moving the patient to a negative pres-
sure room, performing a chest x-ray (CXR), sending the specimen
for M. Tuberculosis PCR testing and performing a TB quantiferon.
During interview by the ID team, the patient did admit to a his-
tory of a positive TB quantiferon, but stated that her most recent
CXR was negative. Of note, she also reported a history of Bacillus
Calmette-Guerin (BCG) vaccination as a child. Ultimately, the pa-

tient had a normal CXR, a negative PCR for TB, and a positive TB
quantiferon. Given the patient´s positive TB quantiferon and recent
immigration status, she was evaluated at the Health Department´s
TB clinic, and was treated empirically for TB with a nine-month
course of isoniazid, rifampin and pyridoxine. With the exception of
very mild abdominal pain, her symptoms completely resolved fol-
lowing this treatment. Her clinical response to this regimen highly
supported the diagnosis of GU TB.

Approximately two years following surgery, the patient stated
that she was interested in future fertility. She therefore met with a
Maternal Fetal Medicine physician, who stated that it was reason-
able for her to attempt another pregnancy, but with the plan for a
scheduled repeat cesarean delivery at 36 weeks of gestation. At the
time of publication of this case report, the patient was in the process
of trying to get pregnant.

Discussion. In reporting this unexpected case of likely GU TB,
we hope to have highlighted the importance of keeping the disease
on the differential for cases that present similarly. Having a high
index of suspicion for GU TB is important as early diagnosis can
save patients from a prolongation of symptoms as well as unneces-
sary procedures (2, 7). Had this patient been diagnosed with GU
TB earlier, she may not have suffered from chronic pain for so long.
Further research needs to be performed on the pathogenesis of GU
TB. While sexual transmission of TB is the likely mechanism of ac-
tion for most GU TB infections, one review reported that hematoge-
nous dissemination from a pulmonary source may cause 10%−20%
of GU involvement (6). Another hypothesis is that multiple pro-
inflammatory mediators present during menstruation, particularly in
patients with a history of endometriosis, cause proliferation of GU
TB (8). In the patient reported here, it is possible that her wound
may have been infected with TB, and that the TB was then trans-
ferred from the superficial wound to her uterus.

Ultimately, although much improved symptomatically, the pa-
tient does still suffer from mild, intermittent pelvic pain. Addi-
tionally, the patient is currently trying to get pregnant. Hopefully,
after having been treated with anti-tubercular medications, she will
be able to conceive. Fortunately, several case reports have demon-
strated that treatment with anti-tubercular agents heralds a positive
prognosis with complete or near complete resolution of the present-
ing complaints, including infertility (2−5, 7, 9).

Conclusion. Genitourinary TB should be considered in the dif-
ferential diagnosis of pelvic pain or masses in patients from coun-
tries where the disease remains endemic.

1. Ali AA, Abdallah TM (2012) Clinical presentation and epidemiology of female
genital tuberculosis in eastern Sudan. Int J Gynaecol Obstet, 118:236-238.

2. Koc S, Beydilli G, Tulunay G, et al (2006) Peritoneal tuberculosis mimicking
advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol,
103:565-595.

3. Yazdani S, Sadeghi M, Alijanpour A, et al (2016) A case report of peritoneal tu-
berculosis with multiple miliary peritoneal deposits mimicking advanced ovarian
carcinoma. Caspian J Intern Med, 7(1):61-63.

4. Yates JA, Collis OA, Sueblinvong T, et al (2017) Red Snappers and Red Herrings:
Pelvic Tuberculosis Causing Elevated CA 125 and Mimicking Advanced Ovar-
ian Cancer. A Case Report and Literature Review. Hawaii J Med Public Health,
78:220-224.

5. Sachan R, Patel ML, Gupta P, et al (2012) Genital tuberculosis with variable pre-
sentation: a series of three cases. BMJ Case Rep, 101136/bcr-2012-006685.

6. Wise GJ, Shteynshlyuger A (2008) An update on lower urinary tract tuberculosis.
Curr Urol Rep, 9:305-313.

7. Huang D, Carugno T, Patel D (2011) Tuberculous peritonitis presenting as an
acute abdomen: a case report. Am J Obstet Gynecol, 205(1):e11-14.

8. Ghosh SB, Mala YM, Tripathi R, et al (2008) Coexisting genital tuberculosis and
endometriosis presenting as abdominal mass in an infertile woman: a report of
a rare case. Fertil Steril, 90:443.e5-443.e6.

9. Nakahara T, Iwase A, Mori M, et al (2014). Pelvic tuberculous granuloma
successfully treated with laparoscopy to preserve fertility: A case report and
review of the published work. J Obstet Gynaecol Res, 40:1814-1818.

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