Disseminated Hematogenous Tuberculosis Following in vitro Fertilization-Embryo Transfer: A Case Report

Figures & data

Figure 1 (A) few nodular shadows in the upper lobes of both lungs, (B) ground-glass dense opacities in both lungs, (C) multiple nodules in the upper lobes of both lungs, (D) multiple patchy high-density shadows in both lungs with uneven density.

Table 1 Summary of Laboratory Test Indicators in the Patient

Variable	Value	Reference/Normal Range	Elevated/ Normal/Low
Blood cell count
Haemoglobin	75	110–150 g/L	Low
White cell count	9.66×10^9	3.5–9.5×10^9/L	Elevated
Neutrophil	97.0%	40–75%	Elevated
Platelets	141×10^9	125–350×10^9/L	Normal
Lymphocyte count	0.16×10^9	1.1–3.2×10^9/L	Low
Eosinophils	0.01×10^9	0.02–0.52×10^9/L	Low
Infection and inflammatory markers
C-reactive protein	96.7	0–10 mg/L	Elevated
Erythrocyte sedimentation rate	23	0–20 mm/h	Elevated
Procalcitonin	8.89	<0.5 ng/mL	Elevated
Interleukin-6	174.3	0–7 pg/mL	Elevated
Respiratory Virus antibodies	Legionella pneumophila weakly positive	Negative	Elevated
Epstein-Barr Virus DNA	Nuclear antigen IgG 327 U/mL; Capsid antigen IgG 34.5 U/mL	<20 U/mL	Elevated
Cytomegalovirus DNA	IgG positive	Negative	Elevated
Sputum smear (bacterial/fungus)	Normal	-	Normal
Bronchoalveolar lavage fluid culture, blood culture, urine culture	Normal	-	Normal
Legionella pneumophila antigen in urine	Normal	-	Normal
Bronchoalveolar lavage fluid galactomannan	0.22	<0.5 μg/L	Normal
1,3-beta-D-glucan	<10 pg/mL	<60 pg/mL	Normal
Tuberculosis
Tuberculosis-infected T cell	Antigen A 5 SFCs/2.5×10^5 PBMC; Antigen B 0 SFCs/2.5×10^5 PBMC	<6 SFCs/2.5×10E5 PBMC	Normal
Acid-fast stain in sputum smear	Normal	-	Normal
Tuberculin test	Normal	-	Normal
Rheumatology
Autoantibody profile	Normal	-	Normal
Immune	Normal	-	Normal
Rheumatism
C-reaction protein	87.6 mg/L	0–10 mg/L	Elevated
CD8^+T-cells	30.29%	18.1–29.6%	Elevated
CD4^+/CD8^+ T-cells	1.57	0.8–2.1	Normal
Thyroid function	Normal	-	Normal
Liver and kidney function	Normal	-	Normal
Albumin	19.1	40–55 g/L	Low
Coagulation profile	Normal	-	Normal
Arterial blood gas (mechanical ventilation; PEEP, 12 cmH2O; FiO2, 100%)
PH	7.335	7.35–7.45	Low
PCO2	32	35–45	Low
PaO2	83	83–108	Normal
HCO3^−	17.9	21–27 mmol/L	Low
BE	−8.0	−3 to +3	Low
Lactate	3.6	0.5–1.6 mmol/L	Elevated
Urinalysis
Protein	2+	-	Elevated
Occult blood	3+	-	Elevated
White blood cell	-	-	Normal
Myocardial enzyme
LDH	1073 U/L	120–250 U/L	Elevated
HBDH	767 U/L	72–182 U/L	Elevated
CK, CKMB	Normal	-	Normal
NT-proBNP	162.3 pg/mL	0–125 pg/mL	Elevated
Faeces test	Normal	-	Normal

Abbreviations: PEEP, positive end expiratory pressure; FiO2, fraction of inspiration O₂; PH, pondus hydrogenii; PCO₂, partial pressure of carbon dioxide; PaO₂, arterial partial pressure of oxygen; HCO3-, bicarbonate; BE, base excess; LDH, lactate dehydrogenase; HBDH, hydroxybutyrate dehydrogenase; CK, creatine kinase; CKMB, creatine kinase myocardial band; NT-proBNP, N-terminal pro-brain natriuretic peptide.

Table 2 Summary of Ultrasound and Fiberoptic Bronchoscopy Results in the Patient

Variable	Check Date	Value
Echocardiography	18 Oct.	EF59%, pulmonary artery pressure is 35mmHg, no abnormalities in heart structure and blood flow
Abdominal ultrasound	17 Oct.	No abnormalities
Pelvic ultrasound	17 Oct.	A small amount of fluid (27mm)
Gynecological ultrasound	17 Oct.	Endometrial cavity fluid 23mm×7mm(a little), uterus size 87×69×59(mm), intima media thickness 14mm, uneven echo; Double attachment is normal
Fiberoptic bronchoscopy	17 Oct.	Bronchial patency, the mucosa is slightly congested, the surface was covered with a small amount of yellow sputum scab

Figure 2 (A) A bedside chest X-ray revealed double-lung pneumonia, (B) extensive exudation in both lungs, with small nodules visible, especially in the lower lobes of both lungs.