ArticleBMC infectious diseases2026
Successful treatment of pre-extensively drug-resistant tuberculous meningoencephalomyelitis in pregnancy with a bedaquiline and delamanid-based regimen: a case report.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundManagement of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) during pregnancy poses a formidable clinical challenge, particularly when complicated by tuberculous meningoencephalomyelitis (TBMEM), While the WHO operational handbook provides a general framework for drug-resistant TB, robust evidence and specific guidelines for managing severe CNS involvement in pregnancy remain limited. CASE PRESENTATION: We report the successful outcome for a mother and infant in an extremely high-risk case. The patient, at 17 + 6 weeks of gestation following in vitro fertilization (IVF), was diagnosed with pre-XDR-TB. Hematogenous dissemination was confirmed by chest CT showing diffuse miliary nodules, and spinal MRI confirmed meningoencephalomyelitis. Her clinical course was complicated by life-threatening conditions, including TB-associated sepsis (TB-Sepsis) and severe neurological immune reconstitution inflammatory syndrome (Neuro-IRIS) presenting as an intracranial hypertensive crisis. An individualized, multidisciplinary approach centered on a bedaquiline (Bdq) and delamanid (Dlm)-based regimen was implemented. The patient’s condition was effectively controlled, and she delivered a healthy female infant at 35 + 1 weeks of gestation. Both mother and infant recovered well.
conclusionsThis case demonstrates that a carefully monitored Bdq/Dlm-based regimen can be a life-saving option for severe DR-TB in pregnancy. It also underscores the critical need for systematic TB screening prior to assisted reproductive technology (ART) in high-burden regions.
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