# Tubercular Sinus of Labia Majora: Rare Case Report

Authors: Kela Manoj; Mukherjee Soma; Lunawat Ajay; Agrawal Ashish; Shishodiya Rakesh; R. V. Paliwal
Journal: Infectious Diseases in Obstetrics and Gynecology
 (2008)

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## Abstract

Tuberculosis of the female external genitalia is unusual and primary
infection is rare. We report a 50-year-old female patient admitted to
Department to Surgery with swelling over left inguinal area with discharging sinus from labia majora to left inguinal crease which was found to be tubercular sinus on histopathology.


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## Body

## 1. Introduction

Tuberculosis (TB) of the vulva and vagina is very rare
and it is seen in only 1-2% of genital tract TB. Tuberculosis of cervix accounts
for 0.1–0.65% of all cases of TB and 5–24% of genital tract TB [1–8].
Tuberculosis more frequently affects the upper genital tract, namely, the
fallopian tubes and endometrium. It usually occurs in women of childbearing age
[5, 6, 9].


## 2. Case Report

A 50-year-old female patient without active sexual life
admitted to  Department to Surgery with a swelling over the left inguinal area with discharging sinus from labia majora to left inguinal crease. She had history of incision and drainage for an
abscess at left labia majora 6 months back. She had no history of cough, fever,
or abdominal pain. She had not been in close contact with an index case of pulmonary tuberculosis
in past year. Antibody tests for HIV and VDRL infection were negative.Chest and abdominal X-rays were normal.
Ultrasonography revealed that the uterus was bulky and endometrial line was not
visualized and bilateral adnexae were without a mass or cyst. A full blood count showed leucopenia,
and ESR at 2 hours was 55.Then patient underwent excision of the sinus tract of
labia through suprapubic approach after staining it with methylene blue. A mass
of6×5 cm was excised in the retropubic region
(see Figures 1(a), 1(b), and 2). Histopathology report showed sinus tract lined by chronic inflammatory cells, epitheloid cells,
and Langhan’s giant cells on microscopic examination suggestive of tuberculous
sinus (Figure 3). Antitubreculous quadruple
therapy was initiated. Complete healing of the wound, with rapid relief of
symptoms, followed 4-week antituberculosis chemotherapy.(a)(b)Figure 2Figure 3


## 3. Discussion

Tuberculosis is one of the oldest diseases known to
affect humans [10]. Female genital TB is a rare disease in
some developing countries, but it is a frequent cause of chronic pelvic inflammatory disease (PID) and
infertility in other parts of the world [11]. Symptomatic genital tract TB
usually presents with abnormal vaginal bleeding, menstrual irregularities,
abdominal pain, and constitutional symptom [5, 6, 9, 12, 13]. Pelvic organs are infected from a primary focus, usually the chest, by haematogenous spread [2, 4, 5, 12, 14]. The cervix is infected as part of this process, by lymphatic spread or by
direct extension. The vagina and vulva are rarely involved. The primary lesion
is often healed by the time of presentation [5–9, 12, 13, 14, 15].Chowdhury [5]
has suggested that sputum, used as a sexual lubricant, may also be a route of
transmission. It is uncommon for tuberculosis to involve the vulva and vagina.The gross appearance may be ulcerative with multiple
sinuses, it may be hypertrophic with elephantiasis, or it may be similar to
that of carcinoma. There may be hormone dependence of infection [2, 5] given that 80% of cases occur in the reproductive age.Microscopically, there are caseating granulomatas. These are
not diagnostic. The differential diagnosis for granulomatous disease of the
cervix includes amoebiasis, schistosomiasis, brucellosis, tularaemia,
sarcoidosis, and foreign body reaction. The diagnosis of the cervical and
vulvovaginal TB is usually made by histological examination of cervical and
vulvovaginal biopsy specimen [3, 9, 14]. Staining for acid-fast bacilli was not
found to be very useful in making the diagnosis [16]. The detection of
granulomata on cervical cytology specimens [9, 14] has been documented.
Isolation of the mycobacterium is the gold standard for diagnosis. One third of
cases are culture negative. Therefore, the presence of typical granulomata is
sufficient for diagnosis if other causes of granulomatous cervicitis are
excluded or primary focus identified. The lesion should respond to 6 months of
standard therapy. A lesion on the cervix, vagina, or vulva provides a marker to
assess response to therapy. Histological examination of serial biopsy specimens
can similarly confirm a therapeutic response.



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