A25-04 Severe Tuberculosis-Related Acute Respiratory Distress Syndrome in Early Pregnancy Following in Vitro Fertilization: A Case Report and Clinical Insights

Abstract Background Tuberculosis (TB) remains a major non-obstetric cause of maternal mortality. In vitro fertilization and early pregnancy can reactivate latent TB due to altered cellular immunity. Tuberculosis-related acute respiratory distress syndrome (TB-ARDS) is rare but carries a mortality rate of 60-90%. Extracorporeal membrane oxygenation (ECMO) may serve as a life-saving therapy in such cases. Case Presentation A 31-year-old woman, 16 weeks pregnant after in vitro fertilization and embryo transfer (IVF-ET), was admitted with cough, sputum, fever, and progressive dyspnea. Chest CT revealed diffuse bilateral infiltrates. Bronchoalveolar lavage fluid tested positive for Mycobacterium tuberculosis by smear, culture, GeneXpert, and metagenomic next-generation sequencing (mNGS).She rapidly progressed to acute respiratory distress syndrome and septic shock, requiring invasive ventilation and venovenous ECMO on day 2, later converted to venoarterial mode due to secondary septic cardiomyopathy (LVEF 29%, elevated troponin I 1.1 ng/mL). Multi-drug antitubercular therapy (rifampicin, isoniazid, pyrazinamide, ethambutol, moxifloxacin, and amikacin) was initiated along with antibiotics, corticosteroids, intravenous immunogloblin(IVIG), and nutritional support. Liver dysfunction and coagulopathy necessitated plasma exchange and bile adsorption therapy. Outcome After 3 weeks of ECMO support and comprehensive management, pulmonary imaging showed marked improvement, and oxygenation gradually stabilized. The patient survived, but the pregnancy was not sustained. Discussion TB reactivation following IVF-ET may be precipitated by hormone-induced immunosuppression. Clinicians should be alert to the possibility of disseminated TB and TB-ARDS in pregnant patients. Early identification of TB, immediate initiation of anti-TB therapy, and appropriate ECMO support can significantly improve survival in this otherwise fatal condition. Conclusion This case highlights the critical importance of pre-IVF TB screening and multidisciplinary management of TB-ARDS in pregnancy. ECMO provides a vital rescue strategy for refractory hypoxemia in this rare but life-threatening scenario. This abstract is funded by: none