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Tuberculosis (TB) during pregnancy, especially with central nervous system (CNS) involvement, poses significant risks to maternal and fetal health. This case report explores the diagnostic and therapeutic challenges of managing new-onset seizures in a pregnant patient with CNS-TB. A 23-year-old primigravida presented at 36 weeks gestation with new-onset seizures. The diagnostic workup, complicated by the pregnancy, revealed a left frontal tuberculoma. The patient was started on a standard antitubercular therapy (ATT) regimen of 2HRZE followed by 4HR, taking into account the drugs’ teratogenic potential and fetal safety. Despite the development of mild atonic postpartum hemorrhage (PPH), the patient gave birth to a preterm but viable infant with satisfactory APGAR scores. The interdisciplinary team provided comprehensive care, including seizure management with Levetiracetam and postpartum follow-up for both mother and child. The patient showed neurological improvement and, alongside the newborn, had a favorable outcome. This case underlines the importance of a tailored, multidisciplinary approach to managing TB in pregnancy. It also emphasizes the need for vigilant monitoring and treatment adherence to navigate the complexities of TB with CNS involvement and concurrent pregnancy. Enhanced prenatal screening for TB, interdisciplinary protocols, research on TB medications during pregnancy, and long-term follow-up studies are recommended to improve outcomes for similar future cases.
Gandavaram et al. (Thu,) studied this question.