Can endometrial tuberculosis cause significant weight loss in patients?

Endometrial Tuberculosis and Weight Loss

Yes, endometrial tuberculosis can cause significant weight loss, and this symptom is commonly reported in postmenopausal women presenting with this condition. Weight loss is a classic constitutional symptom of tuberculosis at any site and should raise clinical suspicion for the disease.

Clinical Presentation of Endometrial Tuberculosis

Weight loss is a prominent presenting feature in documented cases of endometrial tuberculosis:

• In postmenopausal women with endometrial TB, weight loss is frequently reported alongside other symptoms such as abdominal pain, ascites, and postmenopausal bleeding 1, 2
• A case series of three postmenopausal women with genital tuberculosis documented weight loss as a presenting symptom in two of the three patients, with one also presenting with a palpable abdominal mass 2
• Another documented case of a 54-year-old woman with endometrial TB presented with the triad of weight loss, abdominal pain, and ascites, initially mimicking malignancy 1

Mechanism and Significance of Weight Loss in Tuberculosis

The weight loss associated with tuberculosis, including endometrial TB, is driven by systemic inflammation and metabolic changes:

• TB patients demonstrate decreased plasma leptin concentrations that correlate with both loss of body fat mass and systemic inflammation, with C-reactive protein and TNF-alpha inversely associated with leptin levels 3
• The inflammatory response in active tuberculosis suppresses leptin production beyond what would be expected from fat loss alone, contributing to loss of appetite and further weight loss 3
• Low leptin production during active TB may contribute to increased disease severity through impaired cell-mediated immunity, particularly in cachectic patients 3

Weight Loss as a Diagnostic Clue

Weight loss should prompt consideration of tuberculosis in the differential diagnosis, particularly in endemic regions:

• The American Thoracic Society recommends considering TB in any patient with constitutional symptoms including weight loss, particularly when accompanied by evening fever, night sweats, and anorexia 4, 5
• The WHO-endorsed symptom screen includes weight loss as one of the key symptoms (along with cough, fever, night sweats, and hemoptysis) that should trigger TB screening, particularly in high-risk populations 4
• Endometrial TB can mimic peritoneal carcinomatosis or endometrial malignancy, making weight loss a critical symptom that should prompt thorough investigation including consideration of TB in endemic areas 6, 2

Clinical Implications

The presence of weight loss in patients with suspected endometrial pathology warrants specific diagnostic considerations:

• When postmenopausal women present with weight loss, ascites, and endometrial thickening, tuberculosis must be included in the differential diagnosis alongside malignancy 1, 6, 2
• Hysteroscopic findings in endometrial TB are not pathognomonic, and the diagnosis requires histopathological evaluation showing epithelioid granulomas and/or detection of acid-fast bacilli 1, 2
• Standard anti-tubercular therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol) results in clinical improvement and weight recovery 1, 2

Weight Recovery During Treatment

Successful TB treatment typically results in weight gain, which serves as a marker of treatment response:

• After 2 months of TB treatment, approximately 32% of patients gain at least 5% body weight, increasing to 62% by the end of treatment 7
• Patients who gain weight during TB treatment do so in a linear fashion throughout the treatment course 7
• Greater burden of disease (cavitary disease, positive smear, positive culture) predicts more substantial weight gain during treatment 7