CHORIOAMNIONITIS AND PERITONEAL TUBERCULOSIS IN PREGNANCY: AN UNEXPECTED DIAGNOSIS AND ADVERSE OBSTETRIC OUTCOME—A CASE REPORT

Abstract

DOI: https://doi.org/10.46296/yc.v10i19.0958

Abstract

Background: Intra-amniotic infection is an important cause of maternal morbidity and adverse perinatal outcomes. Tuberculosis during pregnancy, particularly extrapulmonary disease, may have nonspecific manifestations and consequently be diagnosed late. The coexistence of intra-amniotic infection and peritoneal tuberculosis is rare and poses a diagnostic challenge when fever persists despite antimicrobial therapy and obstetric source control. Case presentation: A pregnant patient at an estimated gestational age of 21.8 weeks was admitted with fever, contraction-like abdominal pain, vaginal bleeding, and leakage of amniotic fluid. Maternal tachycardia, a temperature of 38.6 °C, neutrophilic leukocytosis, and prolonged rupture of membranes were documented. Amniocentesis yielded turbid, yellow fluid with a marked neutrophilic response, undetectable glucose, and abundant gram-positive cocci, supporting the diagnosis of intra-amniotic infection. Because of concerning fetal ultrasonographic findings and ongoing infection, the pregnancy was terminated for medical indications, resulting in delivery of a male fetus weighing approximately 370 g, with no signs of life. High-grade fever, leukocytosis, and severe abdominal pain persisted thereafter. Exploratory laparotomy revealed diffuse peritoneal thickening, multiple whitish-yellow lesions, extensive fibroadhesive changes, and free intraperitoneal fluid with a purulent appearance. Peritoneal biopsy demonstrated necrotizing granulomatous inflammation with Langhans-type giant cells, and peritoneal-fluid culture grew Mycobacterium tuberculosis, confirming peritoneal tuberculosis. Conclusion: Persistent fever after treatment of an apparent obstetric infection should prompt diagnostic reassessment. Peritoneal tuberculosis may coexist with intra-amniotic infection and mimic or prolong obstetric sepsis. Because M. tuberculosis was not documented in the placenta, membranes, or amniotic fluid, a direct causal relationship between tuberculosis and chorioamnionitis cannot be established in this patient.

Keywords: chorioamnionitis; intra-amniotic infection; peritoneal tuberculosis; pregnancy; preterm prelabor rupture of membranes; Mycobacterium tuberculosis.