A case of vulval tuberculosis
Tuberculosis of vulva and vagina is very rare and it is seen in only 1-2% of genital tract TB. Tuberculosis more frequently affects upper genital tract, mainly fallopian tubes and endometrium. It usually occurs in women of childbearing age.

The present case has been published in the Journal of Obstetrics and Gynaecology of India.

A 22 year old married female presented with complaints of ulcerative lesion of vulva since 8-9 months and difficulty in walking. Ulcerative lesion progressively increased in size and was painful. She had history of weight loss and decreased appetite since 1 year. Her menstrual cycles were regular. She was PI LI with 1 full term normal delivery 8 months back at home. Baby was alive and healthy. There was no history suggestive of tuberculosis in past or in the family.

Local examination of vulva revealed ulcerative lesion of left labia majora, left labia minora was eaten up. Right labia majora, right labia minora and clitoris had nodular lesions. There were no palpable inguinal and supraclavicular lymphnodes. Routine investigations and X-ray chest were normal.

Montoux test was positive 35 × 25 mm, ESR 60 mm. HIV and VDRL of husband and wife were negative. After routine investigations examination under anaesthesia was done. Cervix vagina and uterus were found to be normal. Punch biopsy was taken from ulcerative and nodular lesion and sent for histopathology.

Microscopy revealed granuloma comprising of cluster of epitheloid cells with Langhans type giant cells, suggestive of tuberculosis. Patient was started on AKT. 1 month after the treatment, patient had drastic improvement in symptoms and the local lesions regressed by 50%. 4 months after the treatment normal anatomy of vulva was restored. AKT was continued for 9 months.

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