A case report of cervical pregnancy after in vitro fertilization complicated by tuberculosis and a literature review

Abstract

Although female genital tuberculosis may lead to infertility, pregnancy is still possible, especially through in vitro fertilization (IVF). In this eventuality, even latent tuberculosis (TB) infection is prone to reactivate. Because some of the symptoms of TB overlap with those of pregnancy, diagnosis and treatment may be delayed. We report the case of a 30-year-old infertile woman with repeated genital tuberculosis (GTB) who underwent two laparoscopic surgeries and anti-TB treatments. The woman conceived through IVF and, unfortunately, a cervical pregnancy was diagnosed, together with a third recurrence of GTB. When the condition became stable after anti-TB treatment, the pregnancy was terminated using oral mifepristone in combination with an ultrasound-guided local injection of methotrexate. The gestational sac was expelled 4 days later with minimal blood loss. In view of the reciprocal influence and interconnection between IVF, pregnancy, and TB, we conducted a literature review to provide valuable information for early diagnosis and treatment, as well as for routine screening before IVF of TB in infertile patients.

Reactivated disseminated tuberculosis in pregnancy: Case report and review of the literature

“…The incidence of tuberculosis among pregnant women in the United States was 26.6 per 100,000 births from 2003 to 2011, as compared to 5.1–3.4 over that same period in the general population [ 14 , 15 ]. Perhaps better referred to as a “unique immune condition” than a true state of immune suppression, immunomodulatory changes during pregnancy have been hypothesized to contribute to this discrepancy, with pregnancy-related hormonal changes modulating the maternal immune system [ [16] , [17] , [18] , [19] ].…”

“…For example, altered immune processes, such as the suppression of pro-inflammatory cytokines, may play an important role in the cell-mediated immunity responsible for the latency of tuberculosis [ 16 ]. Others comment on the cortisol-mediated vascular permeability of pregnancy, which may facilitate hematogenous dissemination of a reactivated tuberculosis infection [ 16 , 17 , 20 ].…”

“…For example, altered immune processes, such as the suppression of pro-inflammatory cytokines, may play an important role in the cell-mediated immunity responsible for the latency of tuberculosis [ 16 ]. Others comment on the cortisol-mediated vascular permeability of pregnancy, which may facilitate hematogenous dissemination of a reactivated tuberculosis infection [ 16 , 17 , 20 ]. Tuberculosis reactivation during pregnancy may result in maternal signs and symptoms of pulmonary or extrapulmonary disease, or – as in the case with this patient – may also result in spontaneous abortion, fetal malformation, or fetal demise [ 17 , 20 ].…”