Postpartum Disseminated Tuberculosis Masquerading as Severe Sepsis and Pelvic Abscess in a Young Primigravida

Genitourinary tuberculosis (GUTB) remains an underdiagnosed form of extrapulmonary tuberculosis, especially in pregnancy where symptoms overlap with common obstetric and infectious conditions. We report a complex case of a 20-year-old primigravida referred at 33 weeks gestation with fever, dyspnea, anemia, and suspected heart failure following previous blood transfusions. Initial assessments suggested severe malaria, pyelonephritis, and possible chest infection. She subsequently developed preterm labour and delivered a live female neonate at 34 weeks. In the puerperium, she had persistent fever, leukocytosis, elevated ESR, bilateral pleural effusions, and worsening abdominal symptoms. Imaging revealed multiloculated pelvic collections and hepatomegaly. Despite broad-spectrum antibiotics, her condition deteriorated. Emergency laparotomy revealed massive ascites, widespread fibrinous adhesions, pyosalpinx, and numerous tubercles on the bowel surfaces. Histopathology of the fallopian tube confirmed chronic granulomatous inflammation consistent with tuberculosis, and stool GeneXpert detected Mycobacterium tuberculosis. She was commenced on antituberculous therapy (ATT), with subsequent clinical improvement. At follow-up, she developed facial swelling and proteinuria likely secondary to post-TB nephropathy or ATT-related renal involvement, necessitating continued evaluation.\ This case highlights diagnostic difficulties of extrapulmonary TB in pregnancy, the risk of misclassification as bacterial sepsis or malaria, and the potential for dissemination in the immunological milieu of pregnancy and the puerperium. Early use of GeneXpert, heightened clinical suspicion, and multidisciplinary management are essential to preventing morbidity.