Tuberculosis peritonitis presenting as postpartum pyrexia

Tuberculosis (TB) peritonitis is one of the least common causes for puerperal fever. We report a case of pregnant woman in the early 20s who had a preterm vaginal delivery. Following delivery, the patient had persistent episodes of low-grade fever, gradual loss of appetite and lower abdominal distension. On evaluation with CT (positive for ascites, multiple lymph node enlargement and peritoneal thickening), ascitic fluid analysis (exudative with adenosine deaminase positive status) and cartridge-based nucleic acid amplification test (positive for mycobacterium tuberculli), she was diagnosed with TB peritonitis and started on anti-TB treatment (ATT). She was lost to follow-up and came back 2 months later with pyometra. Around 2 L of pus was drained, and antibiotic and ATT were continued. The patient recovered well.This report highlights the importance of evaluating rare causes, such as extrapulmonary tuberculosis, in persistent puerperal fever. Early diagnosis and prompt treatment will prevent maternal mortality and morbidity.