Pregnancy with bilateral tubercular pleural effusion: challenges

Area of Science:

• Critical Care Medicine
• Pulmonology
• Obstetrics

Background:

• Pulmonary tuberculosis (TB) diagnosis in pregnancy is challenging due to overlapping symptoms with physiological changes.
• Pleural effusion occurs in 3-25% of TB cases, typically unilateral.

Purpose of the Study:

• To describe the intensive care management of a pregnant woman with severe respiratory distress and shock due to undiagnosed pulmonary tuberculosis.
• To highlight the role of early bedside lung ultrasonography in diagnosis and management.

Main Methods:

• A pregnant patient presented with life-threatening respiratory distress and shock.
• Bedside lung ultrasonography revealed bilateral pleural effusion.
• Therapeutic thoracocentesis was performed, followed by anti-TB therapy.

Main Results:

• Ultrasonography guided thoracocentesis led to stabilization of respiratory and hemodynamic status.
• Pleural fluid culture confirmed acid-fast bacilli.
• The patient recovered rapidly with anti-TB treatment and mechanical ventilation liberation.

Conclusions:

• Early bedside lung ultrasonography is crucial for diagnosing pleural effusion in critically ill pregnant patients with suspected TB.
• Prompt diagnosis and treatment, including thoracentesis and anti-TB therapy, are vital for successful outcomes.