Menometrorrhagia Resistant To Progestin Treatment in a Secondary Infertile Woman with Pelvic Tuberculosis

Abstract

In the underdeveloped and developing countries, tuberculosis endometritis is still an important infectious disease and community health problem. In cases with infertility, abnormal uterine bleeding resistant to progestin treatment and family history of tuberculosis, genital tuberculosis should be kept in mind.our hospital, patient had progestin therapy for 2 months, but no regression of complaints was obtained. Her medical history revealed that patient's husband had TB infection 16 years ago.Physical examination showed nothing except vaginal bleeding associated with passage of clots. USG examination was normal and laboratory testing's revealed iron deficiency anemia. Given these findings and had a history of progestin therapy, endometrial biopsy was performed. Endometrial biopsy obtained granuloma structures with the multinuclear giant cells and epithelioid histiocytes. Patient chest x-ray showed no evidence of pulmonary TB. Considering these findings, patient accepted as TB endometritis resistant to progestin treatment and received anti-TB therapy for six months (isoniazide, rifampicin, ethambutol, pyrazinamide). Three weeks after the initiation of therapy vaginal bleeding stopped. During the multidrug therapy, there were no adverse effects. At the end of six months of therapy, control endometrial biopsy performed and normal secretory endometrium was reported. The patient was free of disease for 18 months after treatment. DiscussionDespite significant medical advances, TB is still a major factor of mortality from infectious disease [4]. Every year 8 million new TB cases are added to TB patient population and 95% of these patients from undeveloped countries [9]. Because of its different clinical manifestations, genital TB is still a major problem and difficult to diagnose for gynecologists. Genital TB can be latent for years after initial seeding and infection usually occurs by reactivation of organisms from systemic distribution of TB bacillus.Diagnostic tools vary from physical examination to isolation of TB bacillus. Although physical examination is very importance for diagnosis of genital TB, it may reveal nothing [3]. Chest x-ray is the another tool to search primary or secondary TB focus but normal