title: Pregnancy with bilateral tubercular pleural effusion: challenges.
abstract: Pulmonary tuberculosis (TB) during pregnancy mimics some of the physiological changes that occur during pregnancy. Diagnosis is challenging, especially when the patient presents with acute respiratory distress. The incidence of pleural effusion in TB is 3-25% and in the majority of patients, is unilateral. We describe the intensive care management of a 27-year-old pregnant woman admitted to our hospital with life threatening respiratory distress and circulatory shock. She continued to have severe metabolic and respiratory acidosis with shock in spite of the resuscitative measures undertaken. At that point, a bedside lung ultrasonography showed bilateral pleural effusion which was followed with therapeutic thoracocentesis of the right side. This resulted in the stabilization of the respiratory mechanics and haemodynamics of the patient. The pleural fluid culture tested positive for acid fast bacilli after 4 weeks in the intensive care unit. Anti-TB therapy was started and she made a rapid recovery with liberation from mechanical ventilation. The early use of bedside lung ultrasonography was instrumental in the successful management of this patient.
authors.affiliation: Assistant Professor, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Vanita
authors.initials: V
authors.lastname: Ahuja
authors.forename: Satinder
authors.initials: S
authors.lastname: Gombar
authors.forename: Navneet
authors.initials: N
authors.lastname: Kumar
authors.forename: Nitika
authors.initials: N
authors.lastname: Goyal
authors.forename: Kanika
authors.initials: K
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy; D012121:Respiration, Artificial / Q000009:adverse effects; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D014463:Ultrasonography
chemical_list: D000995:Antitubercular Agents
keywords: Pleural effusion; pregnancy; pulmonary tuberculosis; ultrasonography