A 32-year-old woman presents with infertility, menstrual irregularity, and constitutional symptoms. Hysteroscopy reveals an 'ash-leaf' pattern endometrium. Endometrial biopsy shows granulomatous inflammation. Which investigation is MOST specific for confirming genital tuberculosis?

• A Mantoux (tuberculin skin test) > 10 mm induration
• B Chest X-ray showing apical infiltrates
• C Serum adenosine deaminase (ADA) level
• D Endometrial biopsy culture on Löwenstein-Jensen medium ✓

Explanation

Endometrial biopsy culture on Löwenstein-Jensen medium (or BACTEC liquid culture system) demonstrating Mycobacterium tuberculosis is the gold standard for confirming genital tuberculosis. PCR/NAAT on endometrial biopsy is highly sensitive and specific and is increasingly used. Histology showing caseating granulomata is strongly suggestive but not definitive without culture/molecular confirmation. Mantoux and ADA are supportive tests but lack organ-specificity.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.