[A case of tuberculous pyometrium concurrent with tuberculous pleurisy]

An 84-year-old woman began to have low fever below 38 degrees C with slight lassitude from June 19, 2002. Despite oral administration of Clarithromycin for 3 days, the fever did not subside and the lassitude increased, so she was admitted to our department. While inflammatory findings were noticed, the cause was not identified by blood and imaging examinations (thoracoabdominal CT, etc.). Although her tuberculin reaction was positive, symptoms indicative of pulmonary tuberculosis were absent. Administration of Cefotiam and Imipenem Cilastatin sodium was ineffective. Pyometra was diagnosed. After drainage, the uterine cavity was washed every day. On the basis of culture of fluid retained a few colonies of Gram-negative bacteria were isolated, but were not identified, Cefpirome was administered, whereupon the fever subsided gradually, but mild inflammatory findings remained. Even after discharge on July 24, the retention increased, so drainage and washing were done repeatedly. However, mild inflammatory findings persisted. She began to have a fever from September 17 and was readmitted. After admission, administration of Flomoxef sodium was started, but no improvement was seen. A small amount of hydrothorax appeared on the left. Thoracocentesis yielded a bloody, slightly turbid exudative. Acid-fast staining and Mycobacterium tuberculosis specific PCR of pleural effusion were negative, but adenosindeaminase was 87.4 U/l. Therefore, a diagnosis of tuberculous pleurisy was made. DNA/PCR of tubercle bacilli in the fluid retained in the uterus was positive, and re-retention was prevented by administration of anti-tuberculosis drugs. These findings suggest a strong possibility of tubercle bacillus having been the causative bacteria. Particularly in the case of the elderly, it appears important that pyometra be included in differential diagnosis as the cause of fever even without gynecological symptoms and that tubercle bacillus be considered the causative bacterium.