Images in infectious diseases in obstetrics and gynecology. Endometrial tuberculosis.

The images are from a 19-year-old female immigrant from Central America who presented with primary amenorrhea. Pelvic ultrasound (A) shows the presence of intrauterine synechiae vs. septum with punctate cal-cification. Hysterosalpingogram (B) shows a smooth-walled filling defect within the endometrial cavity and obstructed fallopian tubes. The endometrial cavity was also viewed by hysteroscopy (C). Endometrial biopsy (D) confirmed diagnosis of granulomatous endometritis with presence of rare acid-fast bacilli. The diagnosis of endometrial tuberculosis should be considered in women who present with amenorrhea or infertility, especially if they have lived in "third-world" countries.