Atypical cause of fever in advanced pregnancy

Although miliary tuberculosis (TB) is uncommon in pregnancy, it is difficult to diagnose when present and is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus (HIV) infection. TB in pregnancy can present with non-pulmonary symptoms, making the diagnosis and treatment challenging. We report a case of military TB in a lady with advanced pregnancy who presented with fever and cough without any history of exposure to TB patient. There was no history of alcoholism, intravenous drug abuse, or any other risk factors. Sputum for acid-fast bacilli stains and HIV screening were negative. The patient was started on anti-TB treatment after blood investigations ruled out other causes of fever and chest radiograph was suggestive of miliary TB. Confirming the diagnosis of miliary TB is an arduous process requiring a high index of suspicion. During pregnancy, histopathologic examination of tissue biopsy and GeneXpert may facilitate making an early diagnosis of extrapulmonary TB.