More Bleeding

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.

Select Relevant Investigations
Full Blood Count

Performed

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

Performed

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

Performed

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

Performed

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

Select Relevant Management
Hysterectomy
Antituberculous therapy
Endometrial ablation
Pelvic radiotherapy