Acute miliary tuberculosis in pregnancy after in vitro fertilization and embryo transfer: a report of seven cases

Xiaoyan Gai,Rong Li,Ping Liu,Wenli Cao,Ying Wang,Yongchang Sun,Weixia Zhang,Lin Zeng,Donghong Song,Lixue Chen,Hongbin Chi

doi:10.1186/s12879-021-06564-z

Abstract

BackgroundWhile miliary tuberculosis (TB) in pregnancy is rare after in vitro fertilization and embryo transfer (IVF-ET), it poses a serious threat to the health of pregnant women and their fetuses. The present study aimed to describe the clinical features of miliary TB and pregnancy outcomes of patients after IVF-ET.MethodsData of infertile patients who received IVF-ET at Peking University Third Hospital between January 2012 and December 2017 were retrospectively analyzed. Patients who developed miliary TB during pregnancy were identified, and clinical characteristics of miliary TB were described.ResultsOut of 62,755 infertile women enrolled, 7137 (11.4 %) showed signs of prior pulmonary TB on chest X-ray (CXR). Among the 15,136 women (mean age: 33.2 ± 5.0 years) who successfully achieved clinical pregnancy, seven patients aged 28–35 years had miliary TB during pregnancy, with two patients having a complication of TB meningitis. All these patients presented with fever. Notably, old TB lesions were detected on CXR in six patients before IVF-ET; nevertheless, no anti-TB therapy was administered. Furthermore, salpingography revealed oviduct obstruction in all patients (7/7). Patients received anti-TB therapy following a diagnosis of miliary TB and were clinically cured. However, pregnancy was terminated due to spontaneous (4/7) and induced (3/7) abortion.ConclusionsTB reactivation, mostly as miliary TB and TB meningitis, is severe in pregnant women after IVF-ET and deleterious to pregnancy outcomes. Signs of prior TB on CXR may be risk factors for TB reactivation during pregnancy.

Highlights

While miliary tuberculosis (TB) in pregnancy is rare after in vitro fertilization and embryo transfer (IVFET), it poses a serious threat to the health of pregnant women and their fetuses
11.4 % (7137/62,755) exhibited signs of prior pulmonary TB prior to in vitro fertilization and embryo transfer (IVF-ET) based on their chest X-ray (CXR) results
At follow-up, two patients achieved pregnancy after second IVF-ET. In this retrospective study, we identified seven cases of active TB during pregnancy from 62,755 cases of IVFET carried out at our hospital. All of these seven cases were diagnosed with acute miliary TB, with two cases complicated by TB meningitis

Summary

Introduction

While miliary tuberculosis (TB) in pregnancy is rare after in vitro fertilization and embryo transfer (IVFET), it poses a serious threat to the health of pregnant women and their fetuses. Acute miliary TB, a more serious and potentially lethal form of the disease, results from massive hematogenous dissemination of Mycobacterium tuberculosis. Approximately 15–30 % of patients with pulmonary TB during pregnancy exhibit hematogenous dissemination and have miliary TB [8]. Because clinical symptoms such as fever and cough are nonspecific and chest X-ray (CXR) and chest computed tomography (CT) scan during pregnancy are associated with a risk of radiation exposure, the diagnosis of miliary TB during pregnancy is often delayed

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