Isolated pelvic tuberculosis mimicking a gynecologic emergency: a case report and review of literature

Introduction and importance: Tuberculosis, an ancient disease caused by Mycobacterium tuberculosis, disproportionately affects low-socioeconomic countries. While pulmonary involvement is most common, extrapulmonary tuberculosis occurs in 10-20% of individuals. Among these, isolated pelvic tuberculosis is a rare presentation. Presentation of case: A 25-year-old mother from Garbo, Somali, Ethiopia presented with a 3-day history of lower abdominal pain, low-grade fever, nausea, and vomiting. She had regular menstrual cycles and resided in a rural, tuberculosis-endemic region. Examination revealed lower quadrant tenderness and a palpable 3 × 3 cm lower abdominal mass. Investigations showed mild anemia and ultrasound revealed a large, loculated pelvic fluid collection extensively filling the Pouch of Douglas and extending superiorly. GeneXpert testing of the aspirated fluid was positive for Mycobacterium tuberculosis. The patient initiated and completed anti-TB treatment, resulting in a full recovery without sequelae. Clinical discussion: Isolated pelvic tuberculosis, though typically presenting with chronic symptoms, can rarely manifest acutely, mimicking a gynecologic emergency as seen in this case. Dissemination occurs hematogenously or directly from nearby organs. Risk factors include patient factors like immunocompromization and environmental factors like poverty. Diagnosis requires a high index of suspicion, followed by imaging and confirmed bacteriological and histopathological examination. Treatment follows guideline-directed anti-TB therapy. Conclusion: Isolated pelvic tuberculosis, usually chronic, can rarely present acutely like a gynecologic emergency, demanding high suspicion. Early diagnosis and guideline-directed treatment are vital to prevent chronic complications and ensure favorable outcomes.