Postpartum tuberculosis: when the immune system wakes up

By:

Kubba, T

Contributor(s):

Govind, A

Publication details: 2017Uniform titles:

BJOG

Online resources:

Summary: Introduction TB remains an important cause of morbidity and mortality worldwide. The UK has one of the highest incidences of TB in Western Europe. Methods We report five cases of postpartum TB presenting to a London District General Hospital. Case 1 A 27-year-old HIV-negative Indian nurse had a normal delivery at 41 weeks. Five months postpartum she developed a tender neck lump. CT scan showed a fluid-filled mass. Aspirate confirmed TB lymphadenitis. Case 2 A 34-year-old HIV-negative Nigerian woman had a normal delivery at 40 weeks. Three months postpartum she presented with abdominal pain and distension. USS showed gross ascites. An ascitic tap confirmed the diagnosis of peritoneal TB. Case 3 A 29-year-old HIV-negative Saudi Arabian woman, had a normal delivery at 40 weeks. Within 48 hours she developed a severe headache. A CT scan showed a soft tissue lesion and she was diagnosed with a tubercular brain abscess. Case 4 A 33-year-old HIV-negative Indian doctor had a normal delivery at 40 weeks. She presented 8 weeks postpartum with shortness of breath. A chest X-ray and pleural tap confirmed a tuberculous pleural effusion. Case 5 A 32-year-old HIV-negative Lithuanian woman miscarried at 22 weeks. Within 24 hours she developed backache and leg weakness. An MRI revealed a lesion consistent with spinal TB. Conclusions Pregnancy is a relatively immunosuppressed state where quiescent/latent TB can be exacerbated. This appears more common postpartum. These cases highlight that TB should be considered as a differential diagnosis in atypical presentations postpartum.  [Conference abstract]

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Introduction TB remains an important cause of morbidity and mortality worldwide. The UK has one of the highest incidences of TB in Western Europe. Methods We report five cases of postpartum TB presenting to a London District General Hospital. Case 1 A 27-year-old HIV-negative Indian nurse had a normal delivery at 41 weeks. Five months postpartum she developed a tender neck lump. CT scan showed a fluid-filled mass. Aspirate confirmed TB lymphadenitis. Case 2 A 34-year-old HIV-negative Nigerian woman had a normal delivery at 40 weeks. Three months postpartum she presented with abdominal pain and distension. USS showed gross ascites. An ascitic tap confirmed the diagnosis of peritoneal TB. Case 3 A 29-year-old HIV-negative Saudi Arabian woman, had a normal delivery at 40 weeks. Within 48 hours she developed a severe headache. A CT scan showed a soft tissue lesion and she was diagnosed with a tubercular brain abscess. Case 4 A 33-year-old HIV-negative Indian doctor had a normal delivery at 40 weeks. She presented 8 weeks postpartum with shortness of breath. A chest X-ray and pleural tap confirmed a tuberculous pleural effusion. Case 5 A 32-year-old HIV-negative Lithuanian woman miscarried at 22 weeks. Within 24 hours she developed backache and leg weakness. An MRI revealed a lesion consistent with spinal TB. Conclusions Pregnancy is a relatively immunosuppressed state where quiescent/latent TB can be exacerbated. This appears more common postpartum. These cases highlight that TB should be considered as a differential diagnosis in atypical presentations postpartum.&nbsp;&nbsp;[Conference abstract]

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