Miscarriage as Initial Presentation of Tuberculosis

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A 31-year-old woman had persistent abdominal pain, and fever, after a miscarriage at 23 weeks of gestational age. Symptoms failed to improve with antibiotics. Exploratory laparoscopy showed evidence of peritoneal and genitourinary granulomatous disease. A loculated effusion developed afterwards without previous evidence of pulmonary involvement. Thoracotomy and endometrial tissue sample showed multisensitive Mycobacterium tuberculosis infection. Her condition was diagnosed as intraperitoneal and endometrial tuberculosis with seeding to pleural space. Intraperitoneal and uterine tuberculous infection usually occurs secondary to hematogenous spread from pulmonary focus. Spread of mycobacteria from adjacent organs and subsequent pulmonary involvement is rare. In our case, documented pulmonary infection came after presentation of uterine and peritoneal infection, suggesting a secondary seeding. In addition, initial symptom was a miscarriage, which makes this an unusual case.

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