Untreated Active Tuberculosis in Pregnancy with Intraocular Dissemination: A Case Report and Review of the Literature

Abstract

Background. Tuberculosis (TB) is a disease that affects hundreds of millions of people across the world. However, the incidence in developed countries has decreased over the past decades causing physicians to become unfamiliar with its unspecific symptoms. Pregnant individuals are especially difficult because many symptoms of active TB can mimic normal physiological changes of pregnancy. We present a case report of a 26-year-old multiparous woman, G4P3003, at 38-week gestation with a history of positive PPD who emigrated from Ghana 6 years ago. She came to the hospital with an initial complaint of suprapubic pain, pressure, and possible leakage of amniotic fluid for the past week. Patient also complained of a productive cough for the past 3 to 4 months with a decrease in vision occurring with the start of pregnancy. Visual acuity was worse than 20/200 in both eyes. Definitive diagnosis of active TB was delayed due to patient refusal of chest X-ray. Fortunately, delay in diagnosis was minimized since patient delivered within 24 hours of admission. Active TB was confirmed with intraocular dissemination. Patient had optic atrophy OS (left eye) and papillitis, choroiditis, and uveitis OD (right eye) due to TB infiltration. Fetus was asymptomatic and anti-TB therapy was started for both patients.

A Case of Multifocal Musculoskeletal Tuberculosis in Pregnant Woman

“…Most of the reported cases of MDR-TB in pregnant were based on retrospective case series or case reports from different parts from the world (India and Lima), mostly pulmonary TB [9][10][11]. Rezai et al had reported extrapulmonary with intraocular dissemination of MDR-TB of pregnant woman at 28 weeks gestational age [12]. The prevalence of extrapulmonary TB (EXPTB) in the Eastern Mediterranean region (which includes Saudi Arabia), according to the WHO, is 22%.…”

Tuberculosis in Pregnancy: Delayed Diagnosis, Lost Lives

“…Tuberculosis in pregnancy can present with vague symptoms, some of them mimicking normal physiology 8 of pregnancy hence leading to delayed diagnosis and treatment. Patients may present with a productive or non-productive cough, chest pains, haemoptysis and generalised body weakness.…”

“…8,9 Therefore a high clinical index of suspicion must be maintained especially among vulnerable groups such as those infected with HIV/AIDS. In patients with productive coughs sputum should be sent for Acid-Alcohol-Fast Bacilli test and histological examination with Ziehl-Neelsen staining.…”