Missed Window, Lost Life: The Deadly Course of TB Meningitis in a Pregnant Woman

Abstract

Tuberculosis meningitis is the most severe form of extrapulmonary TB. TB meningitis has an insidious onset and atypical clinical manifestation. Thus, it is usually in its advanced stage when it is diagnosed resulting in poor therapeutic efficacy and often causing severe extrapulmonary tuberculosis with high mortality. Despite the presence of different diagnostic and treatment modalities, mortality remains unacceptably high. A pregnant female patient was referred to our hospital’s emergency with suspected meningitis with a history of fever and recurrent vomiting. She was being managed conservatively and several tests were done (Complete Hemogram, Metabolic Profile, and Infection Panel). After various neurological investigations, CT scan of the brain revealed a lesion, suspicious of TB meningitis, though not confirmed. She gave birth to a baby girl, after which she felt drowsy. ATT was initiated 5 days post admission, on the day following her delivery. Her condition was still deteriorating. The patient died at last, following which the final diagnosis of TB meningitis came. The following case illustrates the clinical presentation and diagnostic approach in a pregnant lady. TBM diagnosis has many intricacies though the disease is completely curable.