Asian Research Journal of Gynaecology and Obstetrics

Background: Recurrent haematometra is an uncommon clinical presentation that may complicate the diagnosis of female genital tuberculosis. This report describes a young woman with persistent heavy menstrual bleeding, recurrent intrauterine blood accumulation, and an initial radiological impression of adenomyosis.

Case Presentation: A 28-year-old unmarried woman presented with irregular menstrual cycles, heavy menstrual bleeding, severe abdominal pain, dizziness, weakness, and anaemia. Ultrasonography and pelvic magnetic resonance imaging showed an enlarged uterus with blood products and clots in the endometrial cavity, together with findings suggestive of adenomyosis. Cervical dilatation and evacuation removed approximately 110 mL of blood and clots; however, haematometra and heavy bleeding recurred. Subsequent abdominal imaging demonstrated periportal, peripancreatic, pre-aortic, and para-aortic necrotic lymphadenopathy, raising suspicion of extrapulmonary tuberculosis. Anti-tubercular therapy was initiated empirically. Five months later, aspirated material from an enlarged right supraclavicular lymph node tested positive for Mycobacterium tuberculosis complex by cartridge-based nucleic acid amplification testing, with no rifampicin resistance detected. Treatment was complicated by drug-induced hepatitis and recurrent bleeding, requiring modification of the anti-tubercular regimen and continued hormonal and supportive management.

Outcome: Following prolonged treatment, uterine size and haematological parameters normalised, and regular menstrual cycles with moderate flow resumed, although occasional tranexamic acid remained necessary.

Conclusion: Female genital tuberculosis should be considered in recurrent haematometra when imaging demonstrates necrotic lymphadenopathy or other evidence of extrapulmonary disease.