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November 28, 1980

Tuberculous Meningitis in a Puerperal Woman

Author Affiliations

From the Department of Medicine, The New York Hospital-Cornell University Medical Center, New York. Dr Brandstetter is now with the Pulmonary Unit, Massachusetts General Hospital, Boston.

JAMA. 1980;244(21):2440. doi:10.1001/jama.1980.03310210042025

ALTHOUGH tuberculous meningitis (TBM) rarely complicates pregnancy and seldom occurs in puerperal women,1 the prognosis for such patients has been surprisingly poor. Despite a younger patient population and the availability of effective antituberculous therapy, between 32% and 68% of pregnant or puerperal women with TBM have died.1,2 We report a case of TBM in a previously healthy woman whose signs and symptoms developed immediately after delivery and were initially attributed to postpartum depression and a puerperal-acquired bacterial infection. Although unusual, this case illustrates another clinical setting in which reactivated tuberculosis may first be manifested.

Report of a Case  After 39 weeks of pregnancy, a previously healthy, 24-year-old woman spontaneously gave birth to a healthy infant. One day later, low-grade fever developed. During the next three days, she became withdrawn and noncommunicative and was thought to be depressed. Fever persisted despite oral cephalexin monohydrate therapy; on the fourth hospital