A Case Report on Tuberculosis in Pregnancy: Highlighting the Necessity of Multidisciplinary Approach and Significance of Tailored Therapy

Tuberculosis (TB) in pregnancy, particularly when the central nervous system (CNS) is affected, presents considerable risks to both maternal and fetal health. The present case report examines the diagnostic and treatment challenges associated with managing new-onset seizures in a pregnant patient diagnosed with CNS-TB.

A 23-year-old primigravida presented at 36 weeks gestation with new-onset seizures. The diagnostic workup, complicated by the pregnancy, revealed a left frontal tuberculoma. The patient was started on a standard antitubercular therapy (ATT) regimen of 2HRZE followed by 4HR (i.e., a combination of four drugs, H- Isoniazid. R- Rifampicin. Z- Pyrazinamide. E- Ethambutol for 2 months followed by isoniazid and rifampicin for 4 months, administered daily), taking into account the drugs’ teratogenic potential and fetal safety. Despite the development of mild atonic postpartum hemorrhage (PPH), the patient gave birth to a preterm but viable infant with satisfactory APGAR scores.

The interdisciplinary team offered comprehensive treatment, which included postpartum follow-up for both mother and child as well as seizure therapy with levetiracetam. Together with the newborn, the patient had a positive outcome and demonstrated neurological improvement.

Thus, this case highlights the significance of a customized, multidisciplinary approach to managing TB during pregnancy, particularly with central nervous system involvement. It underscores the necessity for careful monitoring and adherence to treatment to address the complexities associated with TB in pregnant patients.

To enhance outcomes in similar cases, it is recommended to implement improved prenatal screening for TB, establish interdisciplinary protocols, conduct research on the use of TB medications during pregnancy, and carry out long-term follow-up studies.

Source: Gandavaram N, Rajalekshmi M, A case report on tuberculosis in pregnancy revealing the need for an effective multidisciplinary approach and the importance of tailored therapy. Indian J Obstet Gynecol Res. 2024;11(3):515-520.