Hematogenous disseminated TB complicating pregnancy and puerperium in a patient with IVF-ET: a rare case report and literature review

Backgrounds: Clinicians generally attribute postpartum hyperpyrexia to puerperal infection, often neglecting rare but life-threatening hematogenous disseminated tuberculosis (TB) in pregnancy and the puerperium. Atypical presentations without classic TB toxic symptoms frequently cause diagnostic delays and severe maternal-fetal adverse outcomes. Here we present a case of acute miliary TB complicated with TB meningitis and abdominal TB in a patient with frozen embryo transfer-conceived pregnancy, whose neonate developed congenital TB. This case is unique in the rare coexistence of late-gestational severe disseminated TB, intractable postpartum hyperpyrexia and neonatal congenital TB after assisted reproduction. It adds valuable clinical evidence for peripartum hematogenous disseminated TB and highlights its diagnostic challenges.

Case Description: A 29-year-old woman with secondary infertility (G2P0A1, one previous induced abortion) underwent in vitro fertilization and embryo transfer (IVF-ET). She had no personal or family history of TB. She was admitted at 30⁺⁶ weeks of gestation due to unexplained fever, and received initial symptomatic treatment with physical cooling and cefoxitin. She had spontaneous rupture of membranes at 31 weeks and underwent emergency cesarean section at 32 weeks due to suspected intrauterine infection. Postoperatively, she developed recurrent high fever (peak 39.8 ℃) that was unresponsive to multiple broad-spectrum antibiotics. Further examinations, including chest computed tomography (CT), blood culture, and placental pathology, confirmed hematogenous disseminated TB, tuberculous meningitis, and abdominal TB. The neonate was diagnosed with congenital TB. The patient received standardized anti-TB treatment, and her temperature returned to normal. The neonate was treated with anti-TB therapy and discharged after 90 days of hospitalization. Both maternal and neonatal outcomes were favorable, specifically: the patient had no recurrent fever, no obvious discomfort, and normal results of rechecked chest CT, liver and renal function during follow-up; the neonate had normal growth and development, no TB-related symptoms, and negative TB-related examinations during regular follow-up.

Conclusions: TB in pregnancy/puerperium is insidious, easily confused with puerperal infection. Clinicians should avoid equating puerperal fever with puerperal infection; suspect TB if high fever lasts >48 h (unresponsive to broad-spectrum antibiotics), infection markers mismatch fever, or no obvious signs. Chest tomography and interferon-gamma release assays (IGRAs) serve as important auxiliary tools to facilitate early diagnosis. Early standardized anti-TB treatment and multidisciplinary team (MDT) improve maternal-neonatal outcomes; this case offers clinical reference for such TB.