WOMEN GENITAL TUBERCULOSIS: A STUDY OF TWO CASES AT MOHAMMED VI UNIVERSITY HOSPITAL IN MARRAKECH

Objective: Tuberculosis is a contagious infectious disease caused by the Mycobacterium tuberculosis. It is often pulmonary but in rare cases extrapulmonary such as genital tuberculosis. The aim of this study is to report two cases of genital tuberculosis at the Mohammed VI University Hospital. Case presentation: We report the case of two patients who consulted for different symptomatologies, one for chronic pelvic pain and the second one for primary infertility of 9 years. The investigations carried out led to the diagnosis of genital tuberculosis with endometrial and fallopian tubes localization respectively, which was confirmed by histological examination. Results: Case 1:60-year-old female patient with no previous history of tuberculosis, menopaused, multiparous, consulted for pelvic pain associated with weight loss. Clinical examination was without any particularity. Pelvic ultrasound revealed a 1.5cm glandular-cystic endometrial thickening. NOVAK endometrial biopsy yielded ten millilitres of purulent fluid and endometrial tissue. Cytological examination of the purulent fluid revealed an inflammatory cytology with a predominance of altered leukocytes and no suspicious cells. Pathological examination of the endometrial tissue showed epithelioid and giganto-cellular granulomatous inflammation, with caseous necrosis, suggesting genital tuberculosis. Patient was referred to tuberculosis care center, where an antibacillary treatment was initiated according to protocol 2 ERHZ and 4RH. Case 2: Patient aged 33, genitally active, consulted for primary infertility of 9 years with no other associated signs. The clinical examination was without any particularity. Paraclinical examinations, (hormonal assessment, pelvic ultrasound and the husbands sperm analysis), were without any particularity. The hysterosalpingography noted bilateral tubal obstruction. A laparoscopic surgical procedure revealed a caseous collection in the fallopian tubes, and histological examination was in favour of tuberculosis. Patient was referred to tuberculosis care center for treatment (2ERHZ/4RH protocol), and In Vitro Fertilization was proposed. Conclusion: Genital tuberculosis is a rare pathology, with great clinical variability, so its incidence remains underestimated.