Multidisciplinary management of disseminated tuberculosis with tuberculous meningitis and active hepatitis B in a critically ill pregnant woman in the third trimester: a case report.
Ju Zhao, Liming Zhang, Yun Wang et al.
✦ AI-curated · Sources linked
Case in brief
A 24-year-old woman at 30 weeks’ gestation presented with headache, vomiting, fever, and nuchal rigidity. Cerebrospinal fluid findings confirmed tuberculous meningitis, and chest CT showed diffuse miliary nodules consistent with disseminated tuberculosis. Hepatitis B surface antigen, e-antigen, and core antibody were positive, indicating active viral replication. With intracranial pressure above 330 mmH₂O, osmotic agents were withheld because of fetal safety concerns, and lumbar cisternal drainage was performed. She received an individualized anti-tuberculosis regimen and tenofovir with multidisciplinary care. After stabilization, she delivered a live preterm infant by cesarean section at 36 weeks; mother and infant were discharged without complications.
What made this case unusual
The case combined third-trimester disseminated tuberculosis with tuberculous meningitis and active hepatitis B, while severe intracranial hypertension constrained management options because of fetal safety concerns.
Diagnostic / clinical pearl
In a pregnant patient with meningitic symptoms, cerebrospinal fluid assessment and chest imaging can identify central nervous system and disseminated tuberculosis; concurrent hepatitis B may further complicate treatment planning.
Why it matters
The reported outcome illustrates the role of coordinated multidisciplinary care in managing complex maternal infection alongside critical neurologic illness.