DISSEMINATED TB IN A PREGNANT PATIENT

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: In the United States, most cases occur in foreign-born individuals immigrating from countries with high rates endemic TB [1]. Aggressive dissemination tuberculosis related to pregnancy is rarely reported literature; incidence ranges between 1 and 2% [2, 3]. We report a pregnant patient who developed CNS symptoms was found have numerous brain tuberculomas. CASE PRESENTATION: A 33-year-old F P1001 25+5wga, HIV-negative Haitian woman, presented non-productive cough right lower quadrant pain. Patient-reported recent travel Haiti history positive quantiferon test noted during prenatal period subsequent negative chest x-ray screening.Initially, admission, she started low-grade fevers saturating 96% on room air. Labs were significant for elevated LFTs ALK-PHOS. Initial showed bilateral infiltrates. follow-up chest-CT demonstrated diffuse reticulonodular pattern bilaterally no lymphadenopathy. There concern multi-systemic sarcoidosis. ACE 1,25-(OH)2 Vitamin D levels elevated.The hospital course complicated by new-onset lethargy development late fetal decelerations, resulting an emergent caesarian section. Pulse dose steroids given presumed multisystemic sarcoidosis.Three days post-delivery, endorsed persistent headaches. An acute change mentation neurological exam, raising infection. CT head revealed non-obstructive hydrocephalus hypodensities parietal regions. Follow-up MRI ring-enhancing lesions, along cerebral vasculitis seen MRA. The pathology placental tissue necrotizing granulomatous inflammation abundance acid-fast bacillus. Emergently, treatment tuberculomas brain. DISCUSSION: Meningitis tuberculoma are two common forms intracranial [4]. uncommon patients [5]. pathogenesis initially starts rupture rich focus into subarachnoid space, heralding onset meningitis. adhesions results sequelae [6]. Cerebral imaging essential establish diagnosis disclose hydrocephalus, basilar meningeal thickening, [3]. CONCLUSIONS: Although multidisciplinary approach taken, we feel that administration pulse allowed reactivation disseminated TB, ultimately our patient's demise. REFERENCE #1: Amin S, Stone D, Anderlind C. 32-Year-Old Woman With Miscarriage, Headache, Hepatitis, Disease. Chest. 2019 Apr;155(4):e101-e105. doi: 10.1016/j.chest.2018.10.001. PMID: 30955580. DISCLOSURES: No relevant relationships Rosa Arancibia, source=Web Response Felicia Canaday, Andrew Doodnauth, Khawaja Omar,