Genital Tuberculosis: Coexisting Vulval and Endometrial Tuberculosis in a Multiparous Female

Vulval Tuberculosis (TB) is rare and is diagnosed in only about 0.2% cases of genital tract TB which itself constitutes 0.2 to 2% of all gynaecological cases. Clinically signs and symptoms are variable ranging from asymptomatic to infertility and chronic Pelvic Inflammatory Diseases (PID). Female genital tract is involved via haematogenous or lymphatic dissemination or from direct contiguity from a primary focus of infection elsewhere in the body. Diagnosis of vulval or endometrial TB is made on histopathological examination of lesions which show classical caseating granulomas. Demonstration of Mycobacterium is considered as gold standard. Authors in the past have found typical epitheloid granulomas but failed to obtain positive results on ZN staining. We hereby present a rare case of TB of vulva in an unsuspecting multiparous middle aged female who presented with two years amenorrhoea, burning micturition and difficulty in walking, backache and lower abdominal pain off and on and a popular ulceration on inner aspect of labia minora. The patient was clinically misdiagnosed as pelvic inflammatory disease. Investigations following diagnosis of vulval TB helped discover underlying co existent endometrial tubercular involvement as well. In present case Acid Fast Bacilli (AFB) were identified on ZN staining of the histopathology sections.