The Placenta as a Diagnostic Specimen in Disseminated Tuberculosis of Pregnancy presenting as Acute Respiratory Distress Syndrome – A case report
- 1Department of General Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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 Empirical antitubercular therapy begun in the third week was withdrawn for hepatotoxicity.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.
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BibTeX
@article{zutshi2026placenta,
title = {{The Placenta as a Diagnostic Specimen in Disseminated Tuberculosis of Pregnancy presenting as Acute Respiratory Distress Syndrome – A case report}},
author = {Bhvika Zutshi and Sandeep Garg and Praveen Bharti and Amit Kumar and Annesha Chakraborty and Priyadarshi Meena},
journal = {IDCases},
year = {2026},
month = oct,
doi = {10.1016/j.idcr.2026.e02810},
url = {https://doi.org/10.1016/j.idcr.2026.e02810},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Placenta as a Diagnostic Specimen in Disseminated Tuberculosis of Pregnancy presenting as Acute Respiratory Distress Syndrome – A case report
AU - Bhvika Zutshi
AU - Sandeep Garg
AU - Praveen Bharti
AU - Amit Kumar
AU - Annesha Chakraborty
AU - Priyadarshi Meena
PY - 2026
DA - 2026/10/24
JO - IDCases
DO - 10.1016/j.idcr.2026.e02810
UR - https://doi.org/10.1016/j.idcr.2026.e02810
AB - 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.
SN - 2214-2509
ER -