Navigating Cervical Cancer Risk in a Patient With Classic Congenital Adrenal Hyperplasia (CAH): A Case Report

Cervical cancer is rarely reported in patients with congenital adrenal hyperplasia (CAH), a condition that may alter risk through hormonal and anatomical factors. When combined with human immunodeficiency virus (HIV), the risk of progression from cervical intraepithelial neoplasia (CIN) to invasive carcinoma may be amplified, yet remains underreported. We report the case of a 57-year-old woman with a history of classic CAH, HIV, cervical intraepithelial neoplasia grade III (CIN III), hypertension, and asthma who presented with abdominal pain and pneumaturia. Imaging revealed air within the vaginal cuff and endometrial canal, raising concern for a fistula. Further evaluation confirmed invasive cervical cancer complicated by vesicovaginal fistula formation. This case highlights the complex interplay between immunosuppression and hormonal dysregulation in cervical cancer pathogenesis. Despite known risk factors, the diagnosis was delayed due to atypical presentation and poor follow-up. Fistula formation added further morbidity and required coordinated multidisciplinary care. In patients with CAH and HIV, cervical cancer may present atypically and be complicated by fistula development. Clinicians should maintain a high index of suspicion and pursue early, coordinated evaluation in patients with overlapping immunologic and endocrine comorbidities.