DOI: https://doi.org/10.36347/sasjs.2026.v12i09.004

Pages: 757-764

Female genital tuberculosis is a rare form of extra-pulmonary tuberculosis, exceptional in adolescents, whose misleading clinical presentation exposes patients to diagnostic delay and permanent tubal damage. We report the case of a 15-year-old girl, with no notable medical history, admitted for pelvic pain evolving for two weeks in a context of vomiting, night sweats and foul-smelling leucorrhoea. Pelvic ultrasound and magnetic resonance imaging (MRI) showed bilateral salpingitis with a voluminous right pyosalpinx and a moderate pelvic effusion associated with signs of peritoneal irritation. Laboratory tests showed a mild inflammatory syndrome with a negative pregnancy test. Chest computed tomography, performed because of the persistence of the clinical picture, revealed a necrotic right pleural empyema associated with disseminated bilateral pulmonary micronodules. Diagnostic laparoscopy showed whitish granulations of miliary tuberculous appearance scattered over the parietal peritoneum, uterine serosa, diaphragmatic dome and hepatic surface, together with a 5 cm right hydrosalpinx and a loculated pseudocyst of the pouch of Douglas. Multiple peritoneal biopsies were taken and sent for histopathological analysis, which revealed a granulomatous lesion of the tubal mucosa composed of epithelioid and giant-cell granulomas, consistent with a tuberculous origin. Given this concordant set of clinical, radiological, intraoperative and histological findings, empirical anti-tuberculous quadritherapy was started. This case underlines the need to systematically consider genito-peritoneal tuberculosis in any adolescent presenting with pyosalpinx or pelvic infection poorly responsive to conventional antibiotics, particularly in tuberculosis-endemic countries, as well as the major diagnostic contribution of laparoscopy with biopsies.