Genital tuberculosis and infertility in a Syrian refugee

Introduction: Tuberculosis (Tb), one of the most globally transmissible disease, remains a major universal health problem. In 2015, 3.5 millions new cases of tuberculosis were identified among women predominantly from developing countries. Given its silent nature, female genital tuberculosis (GTb) is an important cause of significant morbidity and short and long-term consequences such as infertility. Overall among infertile women, GTb accounts for 5-10 % of the cases. Case description: A 22-year-old nulligravid Syrian refugee presented to the hospital Albert Haykel of Lebanon with a 2-year history of primary infertility and chronic dysmenorrhea. While the patient’s chest x-ray was normal, a transvaginal ultrasound showed a retro uterine heterogeneous painless mass and intradermal testing for Tb was positive. Diagnostic laparoscopy revealed a bilateral pyo- or hydro-salpinx as well as peritoneal granulomas that were biopsied. No germ was identified at bacterial cultures or polymerase chain reaction (PCR). The patient was examined after 1 month of empiric treatment for pelvic inflammatory disease but there was no noticeable improvement. A secondary laparoscopy was performed with bilateral salpingectomy and the cultures returned positive for M. tuberculosis. Discussion: Given the silent nature of GTb, a high index of suspicion is required as early as possible to ensure the disease can be treated without causing significant damage to genital organs and permanent sterility. We emphasize the importance of tuberculosis screening for high-risk foreign immigrants coming from dveloping countries where the incidence of Tb is rising, to control its transmission.