A difficult case of diagnosis of bronchial and pulmonary tuberculosis during pregnancy

Abstract

 In Japan, more than 10,000 people are newly diagnosed with tuberculosis each year. We report a case of pregnant women with bronchopulmonary tuberculosis with the difficulties in accurately diagnosis with reflection.

 The patient was a 29-year-old woman with no previous pregnancies. She developed a fever and cough at 15 weeks of gestation, and underwent a thorough examination for persistent fever of unknown origin. However, no abnormalities were found on chest X-ray, and the cause could not be identified even after four weeks. The patient underwent CT at 20 weeks’ gestation, because we thought pulmonary tuberculosis shoud be denied, just in case. Immediately after the diagnosis, a multidrug combination therapy was initiated. She was discharged at 25 weeks’ gestation with negative sputum test and vaginally delivered a male infant weighing 2,850g with Apgar score of 9/9 at 39 weeks’ gestation. The newborn was in good condition with no evidence of tuberculosis infection including the placenta and umbilical cord. In this case, it took four weeks to reach a definitive diagnosis. We should consider pulmonary tuberculosis as one of the differential diagnoses for unexplained cough and febrile condition persisting for more than 2 weeks, even during pregnancy and even with a negative primary screen for pulmonary tuberculosis.