Genital tuberculosis initially presenting as pyometra and progressing to miliary tuberculosis: A case report

Female genital tuberculosis is a rare and often asymptomatic condition, which makes its diagnosis challenging. Early recognition of uncommon clinical presentation of tuberculosis is crucial for the better management of it. We report herein a case of genital tuberculosis that initially presented as pyometra and subsequently progressed to miliary tuberculosis. An 86-year-old woman with a history of immunosuppressive therapy for bullous pemphigoid presented with fever and septic shock and was diagnosed with pyelonephritis. Computed tomography (CT) incidentally revealed pyometra, from which Escherichia coli was isolated, and showed no abnormal findings in the lung fields. At the time, an acid-fast bacillus and histopathological examination had not been conducted. Although she improved with antibiotics, her fever recurred one month later. Repeat CT demonstrated diffuse, granular opacities in the bilateral lungs and an enlargement of the pyometra. Eventually, she was diagnosed with genital tuberculosis co-occurring with miliary tuberculosis. Both the pyometra and miliary tuberculosis improved with anti-tuberculosis treatment. Given the course of pyometra preceding miliary tuberculosis, we speculate that the progression of the tuberculous pyometra caused the disseminated disease. This case emphasizes that delays in the diagnosis of tuberculosis lead to severe disease. Mycobacterium tuberculosis should be considered a potential causative pathogen of pyometra.