# Should miliary tuberculosis be considered as a possible cause of infertility in the new era: a case report and literature review

## TL;DR

A case report shows miliary tuberculosis may cause infertility and should be considered in IVF patients with unexplained symptoms.

## Contribution

Highlights the need to consider MTB as a potential cause of infertility in IVF patients, even in low-TB countries.

## Key findings

- MTB was diagnosed in a woman after multiple IVF attempts with nonspecific symptoms.
- Antituberculosis treatment resolved symptoms and miliary changes in the patient.
- Screening for latent TB is recommended for IVF patients to prevent complications.

## Abstract

Miliary tuberculosis (MTB) is a potentially lethal form of tuberculosis that can occur in pregnant women, especially those who have conceived by in vitro fertilization (IVF).

A 28-year-old, female patient, after IVF’s fourth attempt, at the end of the first trimester, developed a dry cough, high fever, abdominal pain, and vaginal bleeding, which led to the pregnancy termination without resolution of systemic symptoms despite various antibiotics. Because of the appearance of headaches, brain nuclear magnetic resonance (NMR) was done, and diffuse nodular brain lesions were found, which were initially interpreted as metastatic cancer disease. Afterward, the miliary changes were discovered in various organ systems, and the presence of Mycobacterium tuberculosis was confirmed. The antituberculosis treatment was initiated with the standard antituberculosis regimen with excellent clinical response and resolution of miliary changes.

Miliary tuberculosis is more common in cases of pregnancies related to IVF. It should be taken into consideration as a possible risk for infertility in the presence of nonspecific symptoms. Screening methods for latent tuberculosis in IVF patients are needed even in a low-burden TB country.