DISSEMINATED HEMATOGENOUS TB PRESENTING AFTER SPONTANEOUS ABORTION

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Diagnosis of disseminated tuberculosis can be challenging, as symptoms vary significantly and mimic other pathologies (1). Despite being rarely seen in pregnant or post-partum females, its high mortality morbidity warrant prompt diagnosis treatment with clinical suspicion. CASE PRESENTATION: The patient is a 20-year-old female past medical history recent spontaneous abortion who presented progressive dyspnea treated antibiotics 2 months prior. Upon presentation, was hemodynamically stable GCS 14. In the hours following admission, she decompensated quickly requiring intubation vasopressors. CT chest revealed several bilateral cavitary lesions, largest left upper lobe measuring 3.8 x 4.1cm. Transthoracic echocardiogram an ejection fraction 15-19% ventricular thrombosis. Bronchoscopy preformed, resulting Mycobacterium Tuberculosis (MTB) on PCR. Treatment initiated rifabutin, levofloxacin, pyrazinamide, ursodiol, solumedrol. HIV negative. Karius test positive for cytomegalovirus, herpes simplex virus 1, MTB, Candida albicans. Micafungin valganciclovir were added to regimen. patient's course complicated tracheostomy, multiple limb amputations, extended ICU stay. condition slowly stabilized currently pending discharge long-term care facility. DISCUSSION: 2011, there estimated more than 200,000 cases active TB females across globe. While prevalent pregnancy, hematogenous form rare Disseminated mycobacterial infection that either involves blood, bone marrow, liver; two noncontiguous sites. Symptoms resemble variety (2). Less often, patients present acute respiratory failure, cholangitis, hypotension As increases delay treatment, suspicion required, particularly countries where prevalence lower (2).The body's defense against cellular immune response. A physiological change pregnancy results suppression T-helper 1 cells has been thought increase susceptibility infection, reactivation, spread tuberculosis. After delivery, no exacerbated. It hypothesized after our abortion, response reactivated resulted pro-inflammatory CONCLUSIONS: Our case highlights importance considering differential presenting lesions. REFERENCE #1: 1. Barbosa, O. A., Teles, F. M., Maia, A. C. C., Pessoa, G. M. F., de Alencar, I. Sousa, E. T., & Jorge Bezerra Simão, S. D. (2019). puerperium—case report. Oxford Reports, 2019(11), 479–481. https://doi.org/10.1093/omcr/omz116 #2: 2. Wang, J. Y., Hsueh, P. R., K., Jan, S., Lee, L. N., Liaw, Y. Yang, Luh, K. T. (2007). Tuberculosis. Medicine, 86(1), 39–46. https://doi.org/10.1097/md.0b013e318030b605 DISCLOSURES: No relevant relationships by Sarah Cheyney, source=Web Response Mary Reischmann, Crystal Verdick,