Azel Alfonso

Amang Rodriguez Memorial Medical Center
Philippines

Abstract Title: A Missed Diagnosis Of Non-Healing Wound In The Perineum Caused By Tuberculosis In A Pregnant Woman: Case Report.

Biography:

Dr. Azel Alfonso earned her medical degree at the age of 25 years from Far Eastern University – Dr. Nicanor Reyes Medical Foundation, Quezon City, Philippines. She is currently in training as a third year resident of the Department of Obstetrics and Gynecology at Amang Rodriguez Memorial Medical Center in Marikina City, Philippines.

Research Interest:

One of the rare causes of non-healing wound is Mycobacterium tuberculosis. Wound tuberculosis often remains undiagnosed due to lack of suspicion and difficulty in its diagnosis.

A 25-year-old primigravida was admitted due to fever and premature labor at 33-week gestation. Three months prior to admission, on her 21-week gestation, an ulcerative lesion on the right perineal area was noted measuring 0.5 cm in greatest diameter. With no medication, the ulcerative lesion gradually enlarged. On admission, the wound measured 6.0 x 3.0 cm without foul-smelling purulent discharge. On referral to Surgery service, she was given Clindamycin intravenously and was advised daily wound care. HIV screening was non-reactive. Gram stain showed gram positive cocci in clusters, while culture showed moderate growth of Enterobacter cloacae. She was also diagnosed with pulmonary tuberculosis, pneumonia and asymptomatic bacteriuria. She delivered vaginally to an infant weighing 1900 grams on the fourth hospital day. Despite intravenous antibiotics, pyrexia persisted with no improvement of the wound prompting referral to Infectious Disease service. Culture for acid fast bacilli of the pus showed positive on all specimens. Gene Xpert revealed MTB detected, Rifampicin resistance not detected. Biopsy of the lesion revealed severe acute and chronic inflammation, necrosis and focal hemorrhage. The patient was started on antituberculosis medication. She was discharged afebrile with significant improvement of the perineal wound. One year later, she followed up with fully healed wound.

In a pregnant woman presenting with non-healing wound, a high degree of suspicion is required to diagnose tuberculosis as a cause.