Tuberculous endometritis in woman with abnormal uterine bleeding: a case report and literature review

Genital tuberculosis accounts for 15-20% of all extrapulmonary cases, with the endometrium being the second most common site of infection. A 32-year-old native Ethiopian woman presented with intermenstrual vaginal bleeding for the past one month. There was no personal or family history of tuberculosis. The gynecological pelvic exam showed only an enlarged uterus. Transvaginal ultrasound revealed a thickened, heterogeneous and microvacuolar endometrium, with a central area of vascularization. The hysteroscopy picture posed the suspicion of atypical tuberculosis, describing a thickened, friable endometrium with vacuolized and cystic appearance. A positive Mantoux skin test was confirmed by QuantiFERON-TB Gold and then by definitive histological examination. Vaginal bleeding stopped 3 weeks after starting target medical treatment. A year later ultrasound and hysteroscopy were negative.