To present a case of a 36 year-old female at 19 weeks gestation with pregnancy that was achieved with in vitro fertilization (IVF) with worsening headaches and papilledema due to tuberculosis progression of disease from latent tuberculosis to central nervous system tuberculosis.

Miliary tuberculosis, a disseminated form of tuberculosis, is less common in developed countries. Central nervous system (CNS) tuberculosis occurs in 1% of all tuberculosis (TB) cases and is the most devastating form of TB.  Case reports outside the United States have reported miliary tuberculosis in pregnancies with in vitro fertilization. 

36 y.o. female presented to the emergency department at 19 weeks 5 days with worsening headache for one month along with one week of dizziness  and blurred vision. This pregnancy was achieved with in vitro fertilization (IVF). Her history was significant for migration from a farm in Mexico 20 years prior.  Because of her significant headache and neurologic symptoms , she was taken emergently for magnetic resonance imaging (MRI). Her MRI was significant for bilateral hemisphere multiple supra and infratentorial subcentimeter lesions with associated vasogenic edema. Sputum  culture was positive for Mycobacterium bovis.  She was empirically started on dexamethasone, rifampicin , isoniazid, pyrazinamide, and ethambutol secondary to high suspicion of miliary tuberculosis. She continued outpatient treatment with the department of health throughout pregnancy. Repeat brain imaging after delivery noted interval resolution of most brain lesions. The neonate was evaluated without sequela of TB or medication exposure. 

Our review focused on the diagnosis of miliary TB in an IVF pregnancy. While our patient exhibited symptoms that aided in her diagnosis, the overall morbidity remained low for the patient. However, identifying TB prior to pregnancy could have presented an opportunity for treatment. For patients  planning IVF conception, there is  benefit to screening  for TB prior to implantation to optimize maternal health.