A Complex Case of Relapsed Pre-XDR Tuberculosis Complicated by Pregnancy and Congenital Anomaly: Management and Lessons Learned

Abstract

Background: The emergence of drug-resistant tuberculosis, particularly the cases of multidrug-resistant (MDR-TB) and pre-extensively drug-resistant (pre-XDR-TB), proves to be a tremendous barrier to the world's control of TB programs. In addition, if these cases are manifested with the problems of pregnancy and comorbidities, they will be extremely hard to deal with. Case Presentation: We report the case of a 28-year-old female with a chronic pulmonary tuberculosis infection. Initially, she experienced a partial response to a first-line Category-I regimen, which was later followed by a Category-II retreatment regimen that also did not work for her. She was diagnosed with Rifampicin-resistant TB (RR-TB) via GeneXpert and was then cured with a standard MDR-TB regimen. Nevertheless, relapses occurred six months after the treatment was deemed successful. An individualized MDR-TB regimen was started when she was found to be pregnant. Her pregnancy was complicated by poorly controlled diabetes mellitus that required treatment with insulin. A multidisciplinary team, including Pulmonology and Fetomaternal Medicine, managed her case. She delivered a girl baby with a cleft palate that was linked to uncontrolled diabetes. The patient continued her MDR-TB treatment without any signs of perinatal TB transmission. Conclusion: The instance appears to demonstrate adequately the fundamental requirement for rapid drug susceptibility testing (DST), the extremely high relapse risk in drug-resistant TB, and the highly significant need for a multidisciplinary approach to manage MDR-TB in pregnant women. Additionally, it brings home the teratogenic risks tied to uncontrolled maternal diabetes and the necessity for very close monitoring and counseling in such complicated circumstances.