Abstract

Tuberculosis continues to be a major health issue even now in a country like India due to its large population belonging to lower socioeconomic class. Tuberculous spondylodiscitis/Pott’s disease in pregnancy leading to paraplegia is uncommon and is a diagnostic and therapeutic challenge. According to World Health Organisation (WHO), TB is the third leading cause of death worldwide in women of reproductive age group. 21% of global burden of TB in pregnant women is in India. We report a case of a 28 year old, G3A2, at 29 weeks +3 days who presented with progressive bilateral upper limb and lower limb weakness and urinary incontinence. She was evaluated and was diagnosed to have Nurick Grade IV cervical compressive myelopathy with upper motor neuron (UMN) bladder due to tuberculous spondylodiscitis of C4 and C5 vertebrae. She underwent Elective lower segment caesarean section (LSCS) followed by 2 level C4-C5 corpectomy with expandable cage fusion and posterior stabilisation and fusion. Antitubercular regimen for 4 months was started thereafter. With a multidisciplinary approach, there was a good maternal and neonatal outcome. TB in pregnancy mandates early suspicion, diagnosis and treatment for timely intervention to prevent sequential complications to the mother and baby. So in high risk population clinicians should have a high index of suspicion of TB. We here aim to update the knowledge in early diagnosis and management of a rare case of Pott’s disease in the antenatal period which may help clinicians in their practice. Key message: Neurological manifestations in antenatal women especially in high risk groups for TB should prompt clinicians to consider a diagnosis of tuberculosis. Early initiation of anti-tuberculous drugs and if required adjunct surgery provides excellent maternal and neonatal outcome.

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