Disseminated Hematogenous Tuberculosis after Spontaneous Abortion

Abstract

Disseminated tuberculosis is a mycobacterial infection that either involves the blood, bone marrow, liver or two or more noncontiguous sites. While tuberculosis is not uncommon in pregnancy, active, disseminated tuberculosis is exceedingly rare and is associated with poor maternal and fetal outcomes including a ninefold increase in miscarriage. Symptoms of both disseminated tuberculosis in pregnancy can be vague and nonspecific making it difficult to diagnosis. A 20-year-old, immune competent female presented with worsening dyspnea over two months and cavitary lesions on chest imaging. She had been treated with oral antibiotics two months prior and was noted to have an early intrauterine pregnancy at the time. She subsequently miscarried spontaneously. PCR (polymerase chain reaction) testing from brochoalveolar lavage isolated Mycobacterium Tuberculosis. A liquid biopsy (Karius) was positive for Cytomegalovirus, Herpes Simplex Virus 1, and Candida Albicans. The patient had a prolonged and complicated treatment course and ultimately was discharged to inpatient rehabilitation. Disseminated tuberculosis is associated with significant mortality and morbidity warranting prompt treatment with clinical suspicion. Treatment should start when active TB is diagnosed in pregnancy regardless of the trimester. The prenatal care giver is in a unique position to screen and support women who otherwise may not interact with a structured healthcare system.