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

Genital tuberculosis, one of the oldest diseases in history, was first described in mid-eighteenth century and Tuberculosis bacillus (TB) was discovered in 1882 [1]. Although it was thought to be developing countries problem, after the HIV pandemics and increased immigration from developing countries to developed countries due to industrialization, TB has become world’s problem. Five percent of the pelvic inflammatory diseases (PID) are associated with genital TB [2]. Genital TB can be primary or secondary. Primary TB is that first focus that arises from pelvic organs and concomitantly pelvic lymph nodes have the infection. Secondary TB is the form that primary infection begins from somewhere else except pelvic region [3]. Secondary TB almost always has been seen after lung TB. Incidence of the secondary TB after the lung TB is 10% [2]. Most affected organs of the pelvic are tubes (100%), endometrium (50%), ovaries (20%), cervix (5%), respectively while vaginal and vulvar disease are very rare [4-6]. One of the most common symptoms with genital TB is infertility (60%) [7,8]; moreover, menstrual disorders and pelvic pain are not rare [11]. Menstrual disorder usually presents as amenorrhea or oligomenorrhea, menorrhagia, postmenopausal bleeding and dysmenorrhea are relatively rare clinical forms [7,8]. In some very rare cases, the disease presents with abdominal mass and/or ascites. And that can be very challenging to separate this situation from the ovarian cancer. In this case presentation, we represent an endometrial TB case diagnosed during the investigation of abnormal uterine bleeding resistance to progestin therapy. This paper will examine the etiology, diagnosis, and management of obstruction following anti-incontinence surgery and urethral stricture.