Miliary tuberculosis in pregnancy

Although miliary tuberculosis is uncommon in pregnancy, it is difficult to diagnose when present and is often associated with a maternal history of intravenous drug abuse, malignancy, alcoholism, or human immunodeficiency virus infection. This article reports two antepartum cases of miliary tuberculosis without any of these risk factors. Bronchial washings for Pneumocystis carinii and HIV screening were negative for both patients. Acid-fast bacilli stains of the bronchial washing and ascitic fluid were also negative. Several weeks were required for ascitic fluid and bronchial biopsy Mycobacterium cultures to be positive. In contrast, acid-fast bacilli were seen within 24 hours in multiple sections of the delivered placentas. Confirming the diagnosis of miliary tuberculosis is an arduous process requiring a high index of suspicion. During pregnancy, pathologic examination of tissue obtained by placental biopsy may facilitate making an early diagnosis of extrapulmonary tuberculosis.