A Rare Case of Abnormal Uterine Bleeding in a Patient With Rheumatoid Arthritis and Iatrogenic Cushing Syndrome Complicated by Hypertension and Severe Anemia

A 34-year- old unmarried female presented with complaints of heavy menstrual bleeding for 8 months 8 day, associated with passage of clots and lower abdominal pain. The bleeding was sudden in onset and gradually progressive, requiring 4-5 pad changes per day. She had a known history of Rheumatoid Arthritis for one year (Anti-CCP positive) on Methotrexate 7.5mg once weekly and Hydroxychloroquine 200mg twice daily she was also known case of hypertension on Amlodipine 5mg once daily and had developed Iatrogenic Cushing’s syndrome secondary to prolonged corticosteroid use (prednisolone 10mg once daily) she had a recent history of severe anemia requiring two units of blood transfusion. On examination, the patient was hemodynamically stable. Per abdominal examination revealed a 20-week size mass corresponding to a uterine enlargement measuring approximately 8.8cm, nontender in nature. Ultrasonography of the abdomen and pelvis showed a submucosal fibroid measuring 7.3x6.9 cm with increased internal vascularity. The patient was managed with antifibrinolytic (tranexamic acid), iron supplementation, folic acid, antihypertensives, corticosteroids, disease – modifying antirheumatic drugs, and supportive I.V fluids. She subsequently underwent laparoscopic/ open myomectomy. The case highlights the complex interplay between abnormal uterine bleeding secondary to fibroid uterus, chronic auto-immune disease, long-term steroid therapy leading to iatrogenic Cushing’s Syndrome, and resultant severe anemia. Early diagnosis, multidisciplinary management, and careful medication review are essential to optimize outcome in such high-risk gynecological cases.