A 28-year-old woman undergoing evaluation for infertility has a hysteroscopy that reveals a Nance pattern (synechiae with ash-grey granulomatous lesions). Endometrial biopsy reveals caseating granulomas. The hallmark diagnostic test to confirm genital tuberculosis and identify drug resistance is:
- A Mantoux test (TST) ≥10 mm induration
- B Serum adenosine deaminase (ADA) level
- C CBNAAT (GeneXpert MTB/RIF) or culture on endometrial tissue with drug sensitivity testing ✓
- D IGRA (QuantiFERON-TB Gold) blood test
Correct answer: C. CBNAAT (GeneXpert MTB/RIF) or culture on endometrial tissue with drug sensitivity testing
Explanation
While Mantoux test and IGRA indicate mycobacterial exposure, they do not confirm active genital TB or drug resistance. The definitive diagnostic test for genital tuberculosis from endometrial tissue is CBNAAT (GeneXpert MTB/RIF) which provides rapid diagnosis within 2 hours and also detects rifampicin resistance. LPA (line probe assay) and conventional culture with drug susceptibility testing are complementary. Serum ADA supports TB but is non-specific.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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