Abstract :
Tuberculosis is major cause of maternal and fetal morbidity and mortality globally especially in high burden areas. Tuberculous meningitis may manifest in 5-6% of cases. It is most fatal from of extra pulmonary tuberculosis. Early diagnosis can save lives. We report two cases of unusual presentation of tuberculous meningitis in pregnancy. Case 1- Tuberculous meningitis mimicking hyperemesis gravidrum in early pregnancy. Patient hospitalized managed on line of hyperemesis gravidarum, she deteriorated with high grade fever, neck rigidity and became unconscious. Lumbar puncture was performed. Xanthocromic appearance of CSF (cerebro-spinal fluid) with lymphocytosis and high protein favored tuberculosis.
She was started on ATT. Timely diagnosis and treatment lead to favorable pregnancy outcome. Case- 2 Patient in obstructed labor with hand prolapse with septicemia was operated in emergency. She developed tuberculous meningitis with non- communicating hydrocephalous in post-operative period.
On post-op day 3 she had high grade fever and started broad spectrum antibiotics. After showing initial improvement, her condition deteriorated. With severe headache, vomiting and neck stiffness she was unconscious. Her CSF cytology showed high lymphocytic concentration with low glucose. CT
Brain reported non- communicating.hydrocephalus. Even with medical and surgical intervention patient’s condition deteriorated. In both cases usual presentation were related to symptoms of pregnancy. However, failure of improvement lead us to reevaluate our initial clinical diagnosis. The lack of suspicion might have contributed to delay in diagnosis of tuberculous meningitis. Detailed history and thorough examination should be performed so that more serious life threating disorder like tuberculous meningitis is not missed.
Keyword :
Antitubercular treatment (ATT), Hydrocephalous, Tuberculosis tuberculous meningitis.