{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:54:51Z","timestamp":1791273291886,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Tuberous sclerosis complex (TSC) is a rare multisystem genetic disorder characterized by the development of hamartomatous lesions in multiple organs. Although neurologic and dermatologic manifestations commonly lead to diagnosis during childhood, some patients remain undiagnosed until adulthood because of atypical presentations. We report the case of a 28\u2010year\u2010old Ethiopian woman with a longstanding seizure disorder who presented with a two\u2010year history of abnormal uterine bleeding. Physical examination revealed facial angiofibromas and hypomelanotic macules. Further evaluation demonstrated bilateral renal angiomyolipomas, pulmonary lymphangioleiomyomatosis, cortical and subcortical brain lesions, and uterine myometrial lesions compatible with perivascular epithelioid cell tumors (PEComas). Histopathologic examination of a surgically excised renal mass confirmed angiomyolipoma. Based on the presence of multiple major clinical and radiologic features, the patient fulfilled the 2021 International Tuberous Sclerosis Complex diagnostic criteria for a definite diagnosis. This case highlights abnormal uterine bleeding as an uncommon sentinel manifestation of TSC and emphasizes the importance of considering syndromic diagnoses when gynecologic abnormalities coexist with multisystem findings. Early recognition facilitates multidisciplinary management and long\u2010term organ\u2010specific surveillance.<\/jats:p>","DOI":"10.1002\/ccr3.73438","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:49:21Z","timestamp":1788504561000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed Diagnosis of Tuberous Sclerosis Complex Presenting as Abnormal Uterine Bleeding: A Case Report and Literature Review"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1614-5708","authenticated-orcid":false,"given":"Kidus Tesfaye","family":"Bezabih","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana Sisay","family":"Belay","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1461-5695","authenticated-orcid":false,"given":"Merid Lemma","family":"Kebede","sequence":"additional","affiliation":[{"name":"Department of Radiology Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9618-6139","authenticated-orcid":false,"given":"Abebe Ketema","family":"Aderu","sequence":"additional","affiliation":[{"name":"Department of Urology Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathyas Dessalegn","family":"Gebreyes","sequence":"additional","affiliation":[{"name":"Department of Urology Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelil Hussein","family":"Jibicho","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adugna Assefa","family":"Talemahu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias Fikre","family":"Merid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2769-1772","authenticated-orcid":false,"given":"Kedir Negesso","family":"Tukeni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Jimma University  Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00117-022-01053-z"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/iju.13390"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.70520\/kjms.v14i1.255"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","DOI":"10.1590\/2175-8239-jbn-2024-0013en","article-title":"Tuberous Sclerosis Complex and the Kidneys: What Nephrologists Should Know","volume":"46","author":"Monich A. 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