Letter to the Editor: A response to ‘Postmenopausal genital tract tuberculosis’

To the Editor:

I read “Postmenopausal genital tract tuberculosis: A report of two cases in the southern United States” by Dr. Moore and Dr. Dupuy¹ with great interest. I have an interesting case to share with you. I presented it at an International congress of The American Association of Gynecologic Laparoscopists. It was published in The Journal of the American Association of Gynecologic Laparoscopists.²

During my rotatory internship at Riverside Hospital in Toledo, Ohio, some 40-plus years ago, at one of the grand rounds Dr. Abe Steinberg (an ob/gyn attending) asked, “What is the most common cause of infertility in women?” I jumped and said, “genital tuberculosis.” It was my first year in the United States. During my medical college training I was exposed to tuberculosis [as] the most common cause of not just infertility but … of almost every organ or system’s … most destructive condition. Every one stared at me as if I had made [a] seriously wrong statement. It appeared no one had heard of tuberculosis as a cause of infertility.

I had to forget about this incident [and] never again mentioned tuberculosis as a cause of infertility [until] I was taking care of a young well-educated lady for infertility problems in 1994. She had been to different infertility specialists without any success. She had no pelvic symptoms like pain. She was in great health. During the workup of her problem, I decided to do a laparoscopic exploration. [To my] surprise, all the pelvic peritoneum and pelvic organs were studded/covered with small nodules. My assistant was shocked and [thought it might be] secondary from some malignancy. …

I biopsied one nodule. The pathologist’s report confirmed tuberculosis. The pathologist was curious too. He called to discuss this rare finding. The patient had never been exposed to tuberculosis in her community or contacts. She never traveled abroad to countries of possible exposure. She was American-born and raised. In collaboration with an infectious disease [physician] (who had never seen a case like this before), [the patient] underwent antituberculosis treatment for 1 year and was cured of the condition.

Hamid H. Sheikh, MD, FACOG

Lexington, Kentucky

References

1. Moore FA, Dupuy TM. Postmenopausal genital tract tuberculosis: a report of two cases in the southern United States. Contemporary OB/GYN. 2014;59(3):67–70.

2. Sheikh HH. Infertility due to genital tuberculosis. J Am Assoc Gynecol Laparosc. 1996;3(3):453–459.

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In Reply:

Dear Dr. Sheikh: Thank you so much for responding to our article, and I thank you for sharing your interesting case with us. Your interest in this subject and your expertise in diagnosing your patient are commendable, and I hope that our article helps our fellow colleagues to be as mindful of the problem as you obviously are.

Again, thanks for your response and your time.

F. A. Moore, MD