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Central nervous system involvement is noted in approximately 1% of all Tuberculosis (TB) cases. Worsening of pre-existing tubercular lesions following antitubercular treatment in the absence of disease relapse or any other diagnosis is called a paradoxical reaction. We detail an atypical evolution of TB in a pregnant woman. We report the case of a woman admitted with respiratory symptoms at 35 weeks of Pregnancy. She had a spontaneous onset of labor within 48 hours and delivered a 1.6 kg live baby. Investigations confirmed pulmonary TB. She was started on antituberculosis treatment. Post-partum, she developed persistent headaches, and the imaging confirmed tuberculoma in the left inferior frontal gyrus with leptomeningeal enhancement. She was started on steroids. She was readmitted after two weeks due to a new onset holocranial headache, and MRI detected a new large tuberculoma in the temporal region hence, a diagnosis of Pleuropulmonary with Extrapulmonary tuberculosis with a Paradoxical reaction was made. Anti-edema measures were added, and the patient was managed in hospital for another 2 weeks. The case details and the possibility of flare due to puerperium and steroids are discussed. In pregnant women with active TB disease, complications of perinatal death, preterm birth, acute fetal distress, and low birth weight are increased. The risks of untreated active disease in a pregnant woman are higher than the risks of its treatment. A high index of suspicion, avoiding overcrowding, proper nutrition, timely and appropriate initiation of treatment may have a favorable pregnancy outcome.
Sharma et al. (Wed,) studied this question.