Tuberculosis, Endometrial

More Bleeding

Step 1: View clinicals

A 63 year old nulliparous woman from South Asia presents with irregular vaginal bleeding for 4 months. Her menopause occurred 13 years ago. She is not on hormone replacement therapy. A pap smear performed 5 years ago was normal. Her medical history is unremarkable, and she is not on any drugs.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 8,000/mm3 (4,600-11,000) Hb: 11.0 g/dL (11-18) Platelets: 380,000/mm3 (150,000-400,000)

Pelvic Ultrasound

The endometrial thickness is 8mm; there are no adnexal masses; both ovaries appear normal.

Hysteroscopy and Biopsy

There is granulomatous endometritis with microabscesses within the endometrial glands; numerous noncaseating granulomas and epithelioid clusters with giant cells are noted.

Biopsy + AFB, TB-PCR & Culture

Negative for AFB PCR positive for M. Tuberculosis Culture results will be available in 3 weeks


Step 3: Select appropriate management

Hysterectomy
Antituberculous therapy
Endometrial ablation
Pelvic radiotherapy


Score: ★★☆