The Placenta as a Diagnostic Specimen in Disseminated Tuberculosis of Pregnancy presenting as Acute Respiratory Distress Syndrome – A case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Tuberculosis in pregnancy is characteristically paucibacillary, and conventional maternal specimens frequently fail to yield a diagnosis. The placenta is available at every delivery yet is seldom submitted for molecular testing. A 22-year-old unregistered primigravida at 16 weeks of gestation presented with fever, dry cough and progressive dyspnea meeting criteria for the acute respiratory distress syndrome (ARDS). Tuberculin testing was anergic, sputum was unobtainable, bronchoalveolar lavage was precluded by hypoxemia and obstetric risk, and virological, bacteriological, autoimmune and fungal evaluation was unrevealing. Empirical antitubercular therapy begun in the third week was withdrawn for hepatotoxicity. Recrudescent fever with headache yielded a lymphocytic, low-glucose, high-protein cerebrospinal fluid consistent with probable tuberculous meningitis (Marais score 12) despite negative cerebrospinal-fluid nucleic acid amplification (CBNAAT) testing. After spontaneous preterm delivery and neonatal death, imaging demonstrated pulmonary tree-in-bud nodularity and cerebral, cerebellar, and brainstem tuberculomas. Placental histopathology showed caseating granulomatous villitis with Langhans giant cells; Ziehl-Neelsen, Fite, Gomori methenamine silver and Warthin-Starry stains all were negative. CBNAAT of fresh placental tissue detected rifampicin-sensitive Mycobacterium tuberculosis and mycobacterial blood culture subsequently demonstrated bacillemia. The mother improved on anti-tubercular therapy on follow-up. In this review of reported placental tuberculosis, molecular testing consistently outperformed acid-fast staining, and histological appearances were frequently nongranulomatous. The placenta should be submitted fresh for NAAT wherever tuberculosis is suspected in pregnancy, since it can establish the molecular diagnosis and provide rifampicin sensitivity when other maternal specimens have been inconclusive, and satisfies the Cantwell criterion that guides neonatal evaluation.
Source: IDCases
Institution: Maulana Azad Medical College
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,370
OpenAlex ID: W7223455128