Pregnant Women with Fulminant Disseminated TB to the Omentum and Placenta

Baraa K Nabulsi

doi:10.4172/2161-0932.1000225

Abstract

This is a case report of a young 24 year old Somali woman in her 27th week of gestation who was given Rifampicin, Ethambutol, INH, Pyridoxine and Pyrazinamide as a treatment for systemic TB. She did not respond to the treatment. She died because of brainstem infarction (brain death). According to MRI results, multiple brain tuberculomas were seen suggesting brain TB. Brain biopsy was not done and the treatment was initiated at her 27th week of gestation. Patient arrested and was transferred to ICU with GCS of 3-4/15. Cesarean section was done at the 29th week of gestation and the infant was not infected. There were query tuberculosis seeding scattered all over the patient’s omentum and placenta. A specimen was taken for histopathology, which demonstrated that the placenta and omentum contained focal areas of microinfarctions and necrotizing granulomas consistent with tuberculosis. We emphasize that screening should be done during pregnancy to discover dormant infection, asymptomatic disease and to lower the incidence of congenital TB. The aggressive early treatment for dissemination of the disease, especially when associated with pregnancy, and the importance of early diagnosis and therapy will result in regression of the lesions.

Highlights

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has high morbidity and mortality and represents a public health problem, especially in developing countries [1,2]
Tuberculosis is common in immunocompromised patients, and immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycobacteria to any organ including central nervous system, omentum and placenta which is exceedingly rare
The central nervous system infection may manifest as meningitis, abscess or tuberculoma formation [4,5]

Summary

Introduction

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has high morbidity and mortality and represents a public health problem, especially in developing countries [1,2]. Tuberculosis is common in immunocompromised patients, and immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycobacteria to any organ including central nervous system, omentum and placenta which is exceedingly rare. Systemic Review was negative except for dry cough for one month and dyspepsia On physical examination, she was febrile 38.5°C and generally looked ill. At the end of the first week, she started to look very ill and developed a severe headache, throbbing in nature mainly in the temporal area, and she was sweating profusely. She had neck stiffness, but Kernig’s and Brudzinski’s sign’s were negative. In the end of the 3rd week, she had bradycardia and she was not for code

Discussion

Findings

Conclusion