Tuberculosis Caused by Isoniazid-Resistant Strain Was Transmitted from a Woman Undergoing IVFET to Her Fetus by Intrauterine: A Case Report.

Background: Tuberculosis (TB) among women and infants during the perinatal period is not rare, particularly in countries with a high TB burden. And the risk would increase significantly following in vitro fertilization-embryo transfer (IVFET). Worse still, TB in this stage is apt to develop into severe forms in women and neonates, such as disseminated TB or tuberculous meningitis (TBM). On the other hand, severe adverse effects (SAEs) of anti-tuberculosis (ATB) agents in neonates were common but difficult to diagnose early and manage well.

Case presentation: A 29-year-old mother receiving IVFET and her 3-month-old infant were diagnosed with disseminated tuberculosis and cranial tuberculoma on Dec 29, 2024, based on typical imaging features and bacteriological evidence. Intrauterine transmission of an isoniazid-resistant strain was confirmed through whole-genome sequencing (WGS) analysis and epidemiological investigation. ATB therapy and adjuvant treatment were initiated as soon as the confirmation of TB. Favorable therapeutic effects were achieved for them, and their condition stayed well until the last visit on Nov 19, 2024. However, the infant's ATB therapy had to be adjusted several times because of severe drug-induced liver injury (DILI) and lactic acidosis caused by ATB drugs during the treatment. In the end, he also obtained satisfactory outcomes.

Conclusion: Clinicians should stay alert for TB in pregnant women who underwent IVFET as well as their neonates. Our case report may improve clinicians' awareness and ability to manage severe TB during the perinatal period.