Implant tuberculosis: A rare but possible cause in nonhealing surgical wound!

Abstract

Tuberculosis is most commonly involving lungs and less than 20% cases were showing extrapulmonary involvement. Tuberculosis at surgical site is described in medical literature with very few cases in caesarean section surgical incision site. Implant tuberculosis is first time described in literature and is defined as “tuberculosis developed after implantation of mycobacterium tuberculosis bacilli by artificial means without involvement of primary organ or secondary lymphatic and/or hematogenous dissemination.” Caesarean section delivery is a common method of delivery of baby. Surgical site infections resulting to slowly healing to nonhealing wound are commonly reported and usually depend on various factors. Patient factors are immune status and comorbidities of patient. Hospital management factors such as operation theatre infection control policies, sterilization techniques for surgical instruments, and local wound care methods are established and implemented by hospital staff. In this case report, a 34-year-old female with history of caesarean delivery 1 month back presented with nonhealing wound at surgical site. We have done surgical repair with biopsy of wound margins. Wound discharge microscopy was negative for acid fast bacilli with few Gram-positive cocci. Cartridge-based nucleic acid amplification testes were positive for mycobacterium tuberculosis genome. Histopathology shows tuberculous pathology and underlying chronic infectious process for nonhealing wound. We have offered antituberculosis treatment (ATT) as per protocol and observed healing of tuberculous ulcer after 3 months with reappearance of ulcer in the 4th month of ATT. We have topically applied isoniazid and streptomycin over tuberculous ulcer along with systemic ATT. Tuberculous ulcer has responded and noted “cure” as completely healed surgical wound after 6 months of ATT.