SILENT TUBERCULOUS ENDOMETRITIS AS A CAUSE OF PRIMARY AMENORRHEA IN A YOUNG WOMAN FROM A TUBERCULOSIS ENDEMIC COUNTRY: A CASE REPORT

Tuberculosis (TB) is an infectious disease that primarily affects the lungs but can also involve genital organs and the endometrium. Endometrial TB generally has nonspecific clinical manifestations, such as menstrual irregularity causing amenorrhea and infertility. CASE PRESENTATION: A 20-year-old nulliparous patient presented with primary amenorrhea of 20 years. She had no other complaints. She had no response to a 3-month treatment with combined oral contraceptives. Her medical history included a previous TB treatment at age 12. Clinical examination showed appropriate secondary sexual development. Laboratory tests, including thyroid, FSH, LH, estrogen, prolactin, and karyotyping, were normal. MRI revealed a hypoplastic uterus with intraluminal lesions, suggesting uterine synechiae and minimal hematometra. Hysteroscopy and laparoscopy confirmed extensive uterine synechiae and abdominal adhesions. A positive Interferon Gamma Release Assay (IGRA) indicated genital tuberculosis. CONCLUSION: This case highlights the rare occurrence of tuberculosis-related uterine synechiae leading to primary amenorrhea, emphasizing the importance of considering tuberculosis in the differential diagnosis of unexplained primary amenorrhea in TB-endemic regions. © 2025 Ethiopian Society of Obstetricians and Gynecologists (ESOG). All rights reserved.