• A nulliparous, newly married female of 24.5 yrs presented with complaint of offensive, blood mixed vaginal discharge for a few months, post coital bleeding and intermittent spotting.
• Patient also had complaint of mild dull aching pelvic pain and dyspareunia. Bowel and bladder habits normal.
• Examination suggested a lean built with mild pallor. 
• On per speculum examination, cervix revealed friable cervix, bleeds on touch with small papillary growth like lesions.
• No dysmenorrhoea, no heavy bleeding. No significant medical, surgical or family history.
• Patient had history of weight loss and loss of appetite for a few months.

• Image 1. showing friable cervix. Small ulcerative lesion at 9 o’clock. 
• Cervix bleeds on touch.
• As shown in image 2, copious white discharge present.
• Decision of pap smear and biopsy taken. Lesion turned out to be tubercular in origin.
• Further labortatory tests including complete blood count, TB Platinum, liver function tests were done.
• Ultrasound done to tule out any pelvic collections.

• Final diagnosis of Tuberculosis of cervix made.
• Treatment plan of Antitubercular treatment made for a duration of 6 - 9 months as per the recommendations.
• At present patient has completed 4 months of treatment. There is significant improvement in cervical discharge and inflammation and overall general health but patient still complaints of occasional post coital bleeding.
• Barrier contraception has been advised for the duration and patient had husband both had been investigated for HIV status. It has come out negative on two separate occasions 3 months apart.
• Husband has also been investigated for Tuberculosis. He has tested negative. 
• Discussion
• though a rare presentation in developed world, is fairly common in developing countries.(1) Incidence of cervical tuberculosis when compared to overall cases is 0.1 - 0.65% where as in cases of genital tuberculosis it varies from 5 - 24% most common affected part being fallopian tubes. (2)

• Generally primary focus is elsewhere spread to cervix via hematogenous and lymphatic spread. In rare cases primary lesion might be cervix. it is  more commonly sees in immunocompromised cases. (3,4,5)
• Most cases have been reported in reproductive age groups but a few cases have been reported in post menopausal age group as well. (6) 

 

• Macroscopic findings include papillary and vegetative growth, ulcerative lesions mimicking carcinomatous changes. (7)
• Microscopically there casesting/granulomatous changes. (7)
• Gold standard is Mycobacterium tuberculosis on biopsy. Though they may not be seen in one third of the cases. (7) 
• Treatment plan included Anti tubercular regimen involving Isoniazid, Rifampin, Ethambutol and pyrazinamide for six to nine months.

BIbliography

Bibliography
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.JournalofMid-lifeHealth! Apr-Jun2014| Vol5 | IssueCarterJR.Unusualpresentationso fgenitaltract tuberculosis.IntJ GynaecolObstet1990;33:171-6.
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.KollerAB.Granulomatouslesionsoft h ecervixuteriinblackpatients.SouthAfrMedJ1975;49:1228-32
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.RichardsMJ,AngusD.Possiblesexualtransmissiono fgenitourinarytuberculosis.I n tJ TBLungDis 1998;2:439.
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.ChowdhuryN R .Overviewoftuberculosisoft h efemalegenitaltract.J IndianM e dAssoc1996;94:345-61.
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.Tuberculosisofthecervix:Anuncommoncauseofvaginaldischargeinapost-menopausalwoman.Rajesh KumariandAlkaKriplanie ta l .TheNationalMedicalJournalOfIndia.ClinicalCaseReport2018:31:3;149-150
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doi:10.4103/0970-258X.255757PMID:31044761.
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