Clinical Characteristics of Miliary Pulmonary Tuberculosis in Pregnancy After In Vitro Fertilization-Embryo Transfer: A Retrospective Clinical Study.

BACKGROUND AND AIMS: Miliary pulmonary tuberculosis (MPTB) is rare in patients treated with In Vitro fertilization-embryo transfer (IVF-ET), and can be life-threatening to pregnant women and fetuses. We aimed to describe the clinical characteristics of MPTB after IVF-ET and pregnancy outcomes to provide reference for early diagnosis and treatment.

METHODS: Clinical data from patients who developed MPTB after IVF-ET from January 2018-December 2021 were retrospectively and statistically analyzed.

RESULTS: Ultimately, 21 patients (mean age: 29.81 ± 3.79 years) were included. Three patients had a history of pulmonary or extrapulmonary tuberculosis (TB), and were cured or showed no suggestive TB activity before pregnancy. Patients presented with atypical early symptoms, fever (39.16 ± 0.74°C), and vaginal bleeding, and lung imaging changes. Patients became febrile 78.90 ± 26.04 days after IVF-ET; the time from fever to diagnosis was 17.76 ± 9.05 days. Patients were admitted 96.05 ± 25.33 days after IVF-ET. Sputumsmear and culture, purified protein derivative, TB polymerase chain reaction, and other routine TB examinations had low positivity rates; the erythrocyte sedimentation rate was generally within normal limits. Chest imaging during pregnancy is limited, further increasing the diagnosis time. Two critically ill patients were diagnosed by metagenomic next-generation sequencing. Seven patients had TB meningitis or encephalitis. Pregnancy was terminated in all but three patients. All patients received anti-TB therapy; however, two patients died during hospitalization (mean hospitalization: 58.29 ± 33.40 days).

CONCLUSIONS: Comprehensive TB screening before IVF-ET is necessary for infertile patients. MPTB develops after IVF-ET with atypical symptoms and poor pregnancy outcomes. Clinicians should use multiple methods to confirm TB diagnoses early on, without delaying chest imaging.