#342 : Asherman’s Syndrome Attributed to Genital Tuberculosis: A Case Report

Abstract

Background: Asherman’s syndrome is a rare pathology secondary to intrauterine adhesion formation characterized by menstrual disorders and reproductive dysfunction. Although the cause intrauterine adhesion is thought to be associated with vigorous curettage or previous uterine surgery, other causes such as tuberculosis or schistosomiasis leading to intrauterine adhesion, are particularly important in developing countries. Case Presentation: A 33-year-old, multiparous woman, has applied for care to our hospital after 6 months of secondary amenorrhea. Other than occasional untreated heavy vaginal discharge, she had no past medical history nor prior uterine surgical procedure. No one in her family was treated for tuberculosis. Previously she was given combination oral contraceptive pills for 2 months, with no desirable outcome. On June 2022, we conducted a transvaginal ultrasound, with several features suggestive of uterine synechiae i.e. interrupted endometrial line in sagittal plain, small focal cystic areas within endometrium, and hyperechoic lesion with and without posterior shadowing. We decided to perform a hysteroscopy, with findings of mottled endometrium across the fundus and corpus of the uterus. Adhesiolysis was performed. An intrauterine foley catheter was inserted to prevent the reformation of adhesions. The specimen from this procedure were collected for pathology testing, with positive result for endometrial tuberculosis with caseous necrosis. The patient was treated with anti-tuberculosis drugs for 9 months. Upon completion of her tuberculosis treatment, she received combination oral contraceptive pills for endometrial restoration. She had her first period on May 2022, but only scanty bleeding occurred. On July 2022, she had two days of period with heavier blood flow. She is still closely observed. Conclusion: Asherman’s syndrome attributed to genital tuberculosis may emerge in otherwise healthy individual especially in countries where tuberculosis is prevalent. Although the results of hysteroscopic adhesiolysis in Asherman’s syndrome are encouraging, unfortunately, women with Asherman’s syndrome due to genital tuberculosis have poorer prognosis for restoration of menstrual function as there is usually complete destruction of endometrium by the mycobacterial disease. Well-designed clinical trials are needed to determine the most appropriate diagnostic and therapeutic modalities.