Miscarriage as Initial Presentation of TuberculosisCantres-Fonseca, Onix J. MD; Montalvo, Francisco MD; Campos-Santiago, Zulmari MD; Rodríguez-Cintrón, William MDInfectious Diseases in Clinical Practice: September 2013 - Volume 21 - Issue 5 - p e27–e29 doi: 10.1097/IPC.0b013e31827cad21 Case Reports Abstract Author Information Abstract: A 31-year-old woman had persistent abdominal pain, and fever, after a miscarriage at 23 weeks of gestational age. Symptoms failed to improve with antibiotics. Exploratory laparoscopy showed evidence of peritoneal and genitourinary granulomatous disease. A loculated effusion developed afterwards without previous evidence of pulmonary involvement. Thoracotomy and endometrial tissue sample showed multisensitive Mycobacterium tuberculosis infection. Her condition was diagnosed as intraperitoneal and endometrial tuberculosis with seeding to pleural space. Intraperitoneal and uterine tuberculous infection usually occurs secondary to hematogenous spread from pulmonary focus. Spread of mycobacteria from adjacent organs and subsequent pulmonary involvement is rare. In our case, documented pulmonary infection came after presentation of uterine and peritoneal infection, suggesting a secondary seeding. In addition, initial symptom was a miscarriage, which makes this an unusual case. From the Veterans Affair Caribbean Healthcare System, San Juan, PR. Correspondence to: William Rodríguez-Cintrón, MD, Veterans Affair Caribbean Healthcare System, San Juan, PR. E-mail: William@prmail.net. The authors have no funding or conflicts of interest to disclose. © 2013 by Lippincott Williams & Wilkins.