Postpartum Disseminated Tuberculosis Presenting with Tuberculous Meningitis and Flash Pulmonary Oedema: A Multisystem Diagnostic and Management Challenge

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, with extrapulmonary manifestations posing significant diagnostic challenges. Postpartum women are particularly vulnerable due to immune modulation, which may unmask latent TB or precipitate disseminated disease. Case Presentation: We report the case of a 29-year-old postpartum female who presented with fever, headache, and altered sensorium. Neuroimaging revealed parieto-occipital cortical hyperintensities and an internal capsule infarct, while cerebrospinal fluid analysis confirmed tuberculous meningitis (TBM) by GeneXpert MTB/RIF assay. High-resolution CT of the chest demonstrated bronchocentric nodular infiltrates and right lower lobe consolidation suggestive of pulmonary TB with aspiration. The clinical course was complicated by acute respiratory distress, with chest radiographs revealing diffuse bilateral pulmonary infiltrates and echocardiography showing diastolic dysfunction—consistent with flash pulmonary oedema (FPE). The patient responded well to antitubercular therapy, intravenous corticosteroids, and diuretics, with resolution of neurological and respiratory symptoms. Conclusion: This case highlights the complexity of multisystem TB in the postpartum period, presenting simultaneously with central nervous system involvement, pulmonary disease, and life-threatening hemodynamic complications such as FPE. Early multidisciplinary evaluation, integration of imaging, and the use of molecular diagnostics are critical for timely diagnosis and management in such atypical and high-risk presentations.