A70-35 Tuberculosis in the Tube: Rare Presentation of Tubo-Ovarian Abscess in an Immunocompetent Host

Abstract Introduction Tuberculosis (TB) is divided into pulmonary and extrapulmonary infections, with genitourinary TB typically occurring due to lympho-hematogenous spread. In females, the fallopian tubes are the most common site of involvement, presenting as a tubo-ovarian abscess (TOA) or ovarian mass. This case presents a rare instance of a tubo-ovarian abscess caused by a tuberculosis infection in an immunocompetent host. Case Presentation The patient is a 22-year-old female, 6 weeks postpartum from a spontaneous vaginal delivery complicated by preeclampsia and preterm labor at 36 weeks of gestation, who presented to the emergency department with fevers, chills, bodyaches, and abdominal pain. CT of the abdomen revealed a complex cystic mass in the right adnexa measuring 6.7 cm. She underwent percutaneous drainage of the abscess, and cultures, including for acid-fast bacilli (AFB), were negative. CT chest revealed consolidation of the left lower lobe, diffuse bilateral tree-in-bud ground-glass and nodular opacities, and a 9 mm cavitary nodule. Sputum cultures were negative for AFB and TB PCR. HIV testing was negative. She underwent bronchoscopy, which was positive for TB PCR, and transbronchial lung biopsy showing necrotizing granuloma. Notably, the patient’s 6-week-old baby was also hospitalized concurrently and tested positive for TB. The patient was started on directly observed four-drug therapy for TB. Discussion Extrapulmonary TB accounts for 15-20% of all cases, with female pelvic TB representing a small percentage of cases. Symptoms include abdominal pain, weight loss, fevers, fatigue, vaginal bleeding, ascites, and infertility. Since symptoms are nonspecific, imaging plays a crucial role in aiding diagnosis. Pelvic imaging findings may reveal an adnexal mass, a tubo-ovarian mass/abscess, or inflammatory changes, indicative of pelvic inflammatory disease (PID). Diagnosis of pelvic TB requires a high index of suspicion due to nonspecific symptoms and imaging findings. Confirming the diagnosis requires a comprehensive approach. In the case of a tubo-ovarian abscess, the patient underwent percutaneous drainage, which initially ruled out infectious etiologies. Findings on chest CT warranted further investigation with bronchoscopy and biopsy, ultimately confirming the diagnosis. Absence of TB risk factors is a notable aspect of this case. The patient was an immunocompetent host from a non-endemic area. She had a history of marijuana use, but no history of intravenous drug use, congregated living, or occupational exposure. While the risk of PID and TOA is known to be higher in the postpartum state, there is no known correlation with a higher risk of TB infection. This abstract is funded by: None