Multidisciplinary management of disseminated tuberculosis with tuberculous meningitis and active hepatitis B in a critically ill pregnant woman in the third trimester: a case report

Abstract Background Tuberculous meningitis (TBM) in pregnancy is rare but life-threatening, with substantial maternal and fetal risks. Third-trimester disseminated tuberculosis involving the central nervous system with concurrent active hepatitis B infection has scarcely been reported, particularly among remote pastoral populations with limited healthcare access. This report highlights the diagnostic and therapeutic challenges of this triple comorbidity and underscores the value of multidisciplinary team (MDT) management in such complex scenarios. Case presentation A 24-year-old pastoralist at 30 weeks of gestation presented with headache, vomiting, fever, and nuchal rigidity. Cerebrospinal fluidanalysis confirmed TBM, and chest computed tomography revealed diffuse miliary nodules suggestive of hematogenous disseminated tuberculosis. Serology was positive for hepatitis B surface antigen, e-antigen, and core antibody, indicating active viral replication. Given life-threatening intracranial hypertension [intracranial pressure (ICP) > 330 mmH 2 O] in late pregnancy, osmotic agents were withheld for fetal safety, and lumbar cisternal drainage was performed. An MDT comprising respiratory medicine, obstetrics, hepatology, pharmacy, and critical care nursing specialties was assembled. Anti-tuberculosis therapy was intensified to isoniazid, rifampicin, linezolid, and moxifloxacin; ethambutol was discontinued due to fetal optic neuritis, and tenofovir was added for hepatitis B management. Following stabilization, the patient was transferred to a higher-level facility at 35 weeks of gestation and underwent cesarean section at 36 weeks, delivering a live preterm female infant (2320 g, 1-min Apgar score of 8). Both mother and neonate were discharged without complications on December 1, 2025. Conclusions This case demonstrates that early recognition, individualized anti-tuberculosis regimens, and coordinated multidisciplinary collaboration are critical for achieving favorable outcomes in pregnant patients with disseminated tuberculosis complicated by TBM and concurrent hepatitis B infection. The successful management relied on integrated critical care and a multidisciplinary approach, which proved effective even in resource-limited pastoral settings.