ABSTRACT
Spinal tuberculosis (TB) is a rare form of extrapulmonary TB that can be clinically difficult to diagnose, particularly in pregnancy. This 24-year-old G2, P0 patient was diagnosed at 19 weeks gestation, 2 days after a protracted admission for hyperemesis gravidarum, COVID-19 infection, and unexplained transaminitis with bilateral lower limb weakness and urinary retention. She underwent emergent spinal decompression surgery with expectant management on intravenous antitubercular medication and cesarean delivery at 343 weeks gestation. Spinal tuberculosis is a difficult diagnosis, impacted by medical comorbidities, pregnancy, and diagnostic bias. This case describes successful antenatal management of spinal tuberculosis and highlights the importance of interdisciplinary care.
Subject(s)
COVID-19 , Hyperemesis Gravidarum , Tuberculosis, Spinal , Pregnancy , Female , Humans , Young Adult , Adult , Tuberculosis, Spinal/diagnostic imaging , Tuberculosis, Spinal/therapyABSTRACT
BACKGROUND: Treatment of cesarean scar pregnancy is based on clinical context. This report describes two rare complications of conservative management: non-steroidal anti-inflammatory drug-induced methotrexate myelosuppression and myometrial pseudoaneurysm. CASE: A 34-year-old woman was treated conservatively for a cesarean scar pregnancy with systemic methotrexate and intragestational potassium chloride, resulting in pancytopenia secondary to concurrent non-steroidal anti-inflammatory drug use. She presented again with a myometrial pseudoaneurysm, which was treated with bilateral uterine artery embolization and, ultimately, hysterectomy. The final pathology report confirmed a pseudoaneurysm, retained villi within the myometrium, and acute endometritis and myometritis. CONCLUSION: Myelosuppression resulting from use of non-steroidal anti-inflammatory drugs affecting renal excretion of methotrexate can occur at low dosages. Additionally, there is a risk of pseudoaneurysms with vascular damage and trophoblastic tissue. Drug interactions and procedure-related risks must be considered when managing cesarean scar pregnancy conservatively.
