1.Introduction Tuberculosis (TB) is a significant health problem worldwide. The geographic incidence of TB in 2023 has been reported as the following rates per 100 000 person-years (95% CrI: 2242 in Africa , 807 in the Americas, 793 in Eastern Mediterranean, 1184 in Europe, 1419 in South-East Asia and 1104 in Western Pacific. The Global rate is reported to be 1148 per 100,000 person-years (95% CrI) (1). About 25% of the whole world’s population is estimated to be infected with mycobacterium tuberculosis. Although it is a preventable and treatable disease, according to the WHO reports, TB infected about 10 million cases and claimed 1.5 million lives in 2018 (2). It was estimated that the rate of active tuberculosis in pregnancy is rising in the United States (3). Most of these pregnant women lived in Africa and Southeast Asia (4). TB is a significant cause of maternal mortality during pregnancy. Pregnancy-related complications include increased spontaneous abortion rate, suboptimal weight gain in pregnancy, labor before 37 weeks of pregnancy, low birth weight, and enhanced neonatal mortality. Delay in the diagnosis of this infection is an independent factor associated with both increased obstetric morbidities and preterm labor by four- and nine-fold, respectively (5). The vertical transmission rates of TB from mother to the fetus is reported to be low, the same as low reported rates for the viruses like SARS-CoV-2 (6, 7). While TB mainly affects the lungs, about 33% of TB cases might suffer from extrapulmonary disease. The peritoneum is known as a usual extrapulmonary site of TB (8).
Herein, we present a woman with a 16-week spontaneous abortion who was referred to our emergency ward with the acute abdomen features as the first sign of tuberculosis.
2. Case History/ Examination A 20-year-old G2P1Ab1 woman who aborted spontaneously at 16-week pregnancy at home 11 days before, was referred to our hospital with general abdominal pain from 10 days ago. The abdominal pain was intensified and associated with nausea, vomiting, anemia, and massive ascites. She also had complaints of anorexia, fainting, and sweating. On the physical examination, the vital signs were reported as follows: PR=120/min, BP=90/60mmHg, RR=18/min, OT=38̊, and O2sat=97%, and she had abdominal distension with diffuse tenderness and guarding especially in the lower abdomen, and positive cervical motion tenderness suggestive of a hemorrhage or massive ascites. Transvaginal ultrasonography confirmed the presence of ascites (Figure 1-2). Laboratory data revealed Hb=5/6 gr/dL, white blood count of 6100, C reactive protein= 3+, and ESR=120. In addition, U/A, U/C, and PCR for COVID-19 were evaluated due to abdominal pain and coronavirus pandemic. The results of tests performed to evaluate renal function and blood levels of hepatic transaminases did not indicate unusual values.