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 During the next three days, she became withdrawn and noncommunicative and was thought to be depressed.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