Thoracoabdominal endometriosis mimicking pulmonary tuberculosis in a TB-endemic setting: a case report

Endometriosis is a common gynecologic condition, but extra-pelvic manifestations are rare and often pose significant diagnostic challenges. Thoracic and abdominal endometriosis may present with nonspecific respiratory and abdominal symptoms that closely mimic pulmonary tuberculosis, particularly in TB-endemic regions, leading to delayed or incorrect diagnosis.

We report the case of a 40-year-old Tanzanian woman with a previous history of treated pulmonary tuberculosis who presented with a 6-month history of progressive shortness of breath, right-sided chest pain, and abdominal distension. Imaging revealed a massive right hydropneumothorax with near-total lung collapse and ascites, initially raising concern for post-tuberculous disease. Pleural fluid cytology demonstrated a hemorrhagic effusion. Diagnostic laparoscopy revealed hemorrhagic ascites, mesenteric nodular lesions, and extensive uterine adhesions. Histopathological examination of the mesenteric nodules confirmed endometriosis. The patient was treated with gonadotropin-releasing hormone agonist therapy (goserelin) and underwent pleurodesis, with subsequent clinical improvement and resolution of symptoms.

This case highlights thoracoabdominal endometriosis as an important differential diagnosis in women of reproductive age presenting with unexplained respiratory symptoms in TB-endemic settings. Awareness of this rare entity is essential to avoid misdiagnosis and unnecessary anti-tuberculous therapy. Early consideration of extra-pelvic endometriosis and timely histological confirmation can facilitate appropriate management and improve patient outcomes.