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

Abstract

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. Sputum Mycobacterium tuberculosis smear 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.

Keywords: In Vitro fertilization‐embryo transfer; female infertility; lung infection; metagenomic next‐generation sequencing; pregnancy; tuberculosis.

Figure 1

A 26‐year‐old infertile woman presented with fever at 8 weeks + 4 days of gestation. (A) Posteroanterior chest radiograph showing miliary nodules and patchy blurred shadows in both lungs. (B) Chest CT showed miliary nodules with multiple patchy exudation and ground‐glass opacity, in both lungswith uneven density. (C) Histopathological picture of placenta in uterine cavity after termination of pregnancy (HE 10×). (D) Nucleotide position along Mycobacterium tuberculosis (10 K). Mycobacterium tuberculosis 0.0051% coverage.