A woman with primary infertility and scanty menses undergoes hysteroscopy, which shows an obliterated uterine cavity with no visible ostia, pale avascular synechiae. Endometrial biopsy shows caseating granulomas. The most likely diagnosis is:
- A Intrauterine adhesions from prior instrumentation (Asherman syndrome)
- B Genital tuberculosis ✓
- C Endometrial sarcoidosis
- D Chronic non-specific endometritis
Correct answer: B. Genital tuberculosis
Explanation
Caseating granulomas on endometrial biopsy are pathognomonic of genital tuberculosis. Genital TB is a leading cause of primary infertility in India, typically affecting the fallopian tubes first then the endometrium, leading to tubal occlusion and Asherman-like intrauterine adhesions. The combination of infertility, hypomenorrhea, obliterated cavity on hysteroscopy, and caseating granulomas strongly indicates TB endometritis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.