Genital tuberculosis affecting prepubertal girls is extremely uncommon, posing a great diagnostic challenge. It is a form of extrapulmonary tuberculosis usually seen in the reproductive age group. It can lead to significant health problems, including infertility, pelvic pain, menstrual irregularities in women, or amenorrhea. Genital tuberculosis is even rarer when coupled with an imperforate hymen, thus presenting a rare and diagnostically challenging presentation. Imperforate hymen is an uncommon obstructive congenital abnormality of the female reproductive tract with an incidence of 0.05–0.1%, usually presenting during puberty with primary amenorrhea and hematocolpos or hematometra. Although isolated cases of female genital tuberculosis and imperforate hymen have been reported in literature, the simultaneous occurrence of these two conditions is rarely reported, especially in a prepubertal girl. To our knowledge, this is one of the few case reports from India of a 6-year-old girl presenting with tubercular hematocolpos and an imperforate hymen. We report a case of a 6-year-old North Indian girl who presented with chief complaints of hematuria for 5 days and urinary retention for 1 day. There was a history of fall 1 week back. There was no history of associated cyclical abdominal pain, nausea, vomiting, diarrhea, fever, dysuria, burning micturition, altered bowel habits, or weight loss. She had no secondary sexual characteristics and had not attained menarche. There was no family history of tuberculosis. An abdominal examination revealed a tense abdomen with guarding and rigidity. Local examination of the external genitalia revealed a bulge posterior to the urethral orifice with no hymenal opening. A mass was felt anteriorly on per-rectal examination. Imaging studies depicted imperforate hymen with hematocolpos. She underwent a hymenotomy with drainage of foul-smelling, dark, tarry-colored blood. Postoperative recovery was uneventful, and the patient was discharged on the third day. The vaginal blood was sent for cartridge-based nucleic acid amplification test, which was positive for Mycobacterium tuberculosis complex, and she was given antitubercular drugs for 9 months. Genital tuberculosis-associated hematocolpos with imperforate hymen is a rare condition that can delay diagnosis, leading to increased reproductive morbidity. Considering this, treating doctors should carefully evaluate such patients. Tubercular hematocolpos should be considered in the differential diagnosis of prepubertal girls presenting with obstructive genital anomalies, particularly in tuberculosis-endemic nations. Prompt diagnosis and appropriate management, including hymenotomy and antitubercular therapy, are crucial to avoid misdiagnosis and delayed management.
Garg et al. (Fri,) studied this question.