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

Background 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. Case presentation 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. Similar content being viewed by others Abbreviations - aPPT: - Activated partial prothrombin time - BP: - Blood pressure - CT scan: - Computed tomography scan - CBC: - Complete blood count - HB: - Hemoglobin - HR: - Heart rate - INR: - International normalized ratio - MRI: - Magnetic resonance imaging - PT: - Prothrombin time - PLT: - Platelets - RR: - Respiratory rate - SPO2 : - Oxygen saturation - TB: - Tuberculosis - WBC: - White blood cell

We would like to acknowledge the surgical, obstetrics and gynecology, radiology, and pathology teams for their contributions to the diagnosis and management of this patient. Reporting guidelines This case report has been prepared and reported in accordance with the CARE guidelines. The complete CARE checklist is provided as supplementary material. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate Our institution does not require ethical approval for reporting individual cases or case series. Consent for publication Written consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Competing interests The authors declare that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Lamuwalla, M., Ali, R., Ngimbwa, J. et al. Thoracoabdominal endometriosis mimicking pulmonary tuberculosis in a TB-endemic setting: a case report. J Med Case Reports (2026). https://doi.org/10.1186/s13256-026-06150-4 Received: Accepted: Published: DOI: https://doi.org/10.1186/s13256-026-06150-4