Tubercular cervicitis - A diagnostic dilemma: Report of five cases and literature review

Cervical tuberculosis, a relatively uncommon ailment, primarily targets women in their reproductive years, typically aged between 20 and 45 years, hinting at a possible hormonal influence on infection susceptibility. Its clinical manifestations encompass a spectrum of symptoms ranging from post-coital and intermenstrual bleeding to, in severe instances, infertility, underscoring its significant impact on reproductive health. The disease often masquerades as cervical cancer, with cervical lesions manifesting as either papillary/vegetative growths or ulcerations, necessitating careful examination and diagnosis differentiation. Utilizing the non-invasive yet pivotal tool of cervical Papanicolaou (Pap) smear stands as the cornerstone in the initial investigative approach. Diagnosis hinges on the identification of characteristic features such as epithelioid and Langhans-type giant cells; however, diligent exclusion of other causes of granulomatous cervicitis remains imperative. Supplementary diagnostic modalities including Ziehl-Neelsen (ZN) staining for acid-fast bacilli, fluorescence techniques, colposcopy-guided biopsies, and culture assays play pivotal roles in affirming the presence of the disease. In our presented case series encompassing five patients, each exhibits a unique constellation of symptoms indicative of tubercular cervicitis. In all instances, diagnosis is conclusively established through biopsy confirmation, reinforcing the necessity for a meticulous diagnostic approach in managing this relatively rare yet clinically significant condition.