Home Scholarly articles Extensive caseous necrosis of the endometrium after miscarriage

Extensive caseous necrosis of the endometrium after miscarriage

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A 27-year-old female, G1P0, presented to hospital with one-month amenorrhea after a spontaneous miscarriage. She was free of any cough or fever. Her transvaginal ultrasound revealed a retained product of conception. A diagnostic hysteroscopy showed that the uterine cavity was largely filled with whitish, cheese-like deposits (Figure 1A), with a small piece of identifiable endometrium on the posterior wall (Figure 1B). An endometrial biopsy (Figure 1C) was performed and histopathology revealed caseous necrosis. Chest CT scan also showed pulmonary tuberculosis. Her menstruation recovered at 2 months after the start of anti-tuberculosis treatment with a regular cycle but a remarkably reduced volume. Office hysteroscopy performed one year later revealed thin endometrium with obstruction of both ostia (Figure 1D), and endometrial biopsy was negative for tuberculosis. She tried in vitro fertilization and embryo transfer, but failed due to a thin endometrium.

Figure 1Hysteroscopic findings of extensive endometrial tuberculosis. A: Extensive whitish, cheese-like deposits in the uterine cavity. B: a small identifiable piece of endometrium on the posterior wall. C: endometrial biopsy. D: thin endometrium with obstruction of both ostia during a hysteroscopy performed one year later.