Miliary Tuberculosis Presenting as Postpartum Fever and Back Pain

1Neighborhood Healthcare Hospitalist Group, Palomar Medical Center, Escondido, CA
2Neighborhood Healthcare Hospitalist Group, Palomar Medical Center, Escondido, CA
3Neighborhood Healthcare Hospitalist Group, Palomar Medical Center, Escondido, CA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 136

Case Presentation:

A 24‐year‐old Hispanic woman was admitted 2 weeks postpartum by the obstetricians with fever and back pain and treated empirically for postpartum endometritis. A medical consultation was requested to evaluate for other sources of fever. On exam, she was febrile, tachycardic, and complaining of back pain. Her lung exam revealed some diminished breath sounds in the left upper lobe. Her abdominal exam revealed a nontender, firm fundus and clean incision. Her back exam revealed bilateral flank tenderness, left greater than right. Admission labs showed a normal white count of 7.3 and hematocrit of 28%. Chest x‐ray showed some diffuse reticulonodular prominence throughout both lungs and an asymmetric density in the left upper lobe. A CT scan of the thorax and abdomen revealed a reticulonodular pattern in the lungs with left upper lobe consolidation, bilateral psoas abscesses extending into right iliacus muscles, paravertebral abscesses, and destruction of L2‐L3 with disruption of posterior cortex and soft tissue in the epidural space. Lytic changes were at other lumbar levels, and there were destructive changes in the sacrum. She was immediately placed in respiratory isolation. Her HIV and PPD were negative, serum quantiferon gold TB test was indeterminate. Abscesses noted on the CT scans were drained and were all strongly AFB positive. Miliary tuberculosis was confirmed, and she was started on 4‐drug therapy.

Discussion:

Miliary tuberculosis accounts for 1%‐3% of all tuberculosis cases and refers to uncontrolled, hematogenous dissemination of tuberculosis occurring as a progressive primary infection through a reactivation or iatrogenic route. Risk factors include age, with the elderly and infants more susceptible, and underlying medical conditions that promote immunosuppression, weight loss and malnutrition such as alcohol abuse, malignancy, steroid use, connective tissue disorders, renal failure, diabetes mellitus, and pregnancy. In 8%‐14% of all cases miliary tuberculosis occurs in postpartum women.

Conclusions:

PPD is falsely negative in 10% of immunocompetent active tuberculosis cases. It can be difficult to diagnose tuberculosis in pregnancy, as the symptoms are vague and can easily be masked by the pregnancy; therefore, providers need to have a low threshold to pursue further workup. Treatment during pregnancy is recommended, as there is a higher risk of miscarriage and mortality if untreated.

Author Disclosure:

J. Chuan, MD, Neighborhood Healthcare, employment; S. Pasha, MD, Neighborhood Healthcare, employment; F. Zeeda, MD, Neighborhood Healthcare, employment.

To cite this abstract:

Chuan J, Pasha S, Zeeda F. Miliary Tuberculosis Presenting as Postpartum Fever and Back Pain. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 136. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/miliary-tuberculosis-presenting-as-postpartum-fever-and-back-pain/. Accessed July 22, 2019.

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