Deep infiltrating endometriosis mimicking abdominopelvic tuberculosis in a premenopausal woman: a diagnostic challenge

Abstract

Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis and is characterized by infiltration of pelvic structures beyond the peritoneal surface. Its presentation may occasionally mimic other chronic inflammatory conditions, particularly peritoneal tuberculosis, posing a significant diagnostic challenge in tuberculosis-endemic regions. The coexistence of haemorrhagic peritoneal fluid, dense pelvic adhesions, adnexal masses, and elevated inflammatory markers can obscure the diagnosis and delay definitive management. A 42-year-old multiparous woman presented with chronic pelvic pain, dyspareunia, and dyschezia. On per-vaginal examination, the cervix was found to be pulled upwards and was associated with marked cervical motion tenderness. Comprehensive clinical and radiological evaluation was performed. Magnetic resonance imaging (MRI) findings were suggestive of deep infiltrating endometriosis. A tuberculosis workup was also carried out to exclude genital/ peritoneal tuberculosis. Following thorough evaluation, the patient underwent definitive surgical management in the form of total hysterectomy with bilateral salpingo-oophorectomy. The postoperative course was uneventful, and the patient experienced significant symptomatic relief following surgery.