ENDOMETRIAL TUBERCULOSIS AND BILATERAL TUBERCULOUS SALPINGITIS IN A PATIENT WITH INFERTILITY: A CASE REPORT

Urogenital tuberculosis is an uncommon presentation of Mycobacterium tuberculosis infection, with an incidence that has shown an upward trend among young women. A 39-year-old woman, mixed race (parda), from Salvador (Bahia), sales supervisor, nulligravida, with no history of social vulnerability, immunosuppression, or known contact with tuberculosis cases. In January 2023, during the etiologic investigation of infertility, she was diagnosed with endometrial tuberculosis and bilateral tuberculous salpingitis. At the time of admission, she was asymptomatic and denied constitutional or gynecologic symptoms. She denied a family history of tuberculosis or infertility. She reported continuous use of an oral contraceptive (ethinyl estradiol + gestodene) since age 20, initially prescribed for past pelvic pain with prior emergency department visits, although she had not reported this symptom in more recent years. She had a history of unsuccessful attempts to conceive, including unsuccessful in vitro fertilization. Histopathology (January 2023) showed chronic granulomatous endometritis with foci of necrosis and chronic granulomatous salpingitis, with acid-fast bacilli (AFB) positivity in both endometrial and tubal samples. She was treated with the standard RIPE regimen for nine months, with good clinical response and no complications, and was considered cured of genital tuberculosis. In subsequent evaluations (August 2023 to February 2024), persistent chronic lymphoplasmacytic endometrial inflammation was observed, without documented microbiologic recurrence. A transvaginal ultrasound in September 2023 showed no relevant abnormalities. A cervical Pap smear (January 2025) showed only nonspecific inflammatory changes, with no evidence of intraepithelial lesions or malignancy. Infertility persists, along with emotional distress and frustration. This uncommon presentation is more often diagnosed in younger patients with infertility, as a consequence of a hematogenous focus in the endosalpinx that can spread to the endometrium, ovaries, vagina, and cervix. This case highlights the importance of considering urogenital tuberculosis as an increasingly relevant differential diagnosis in infertility among young women.