Disseminated tuberculosis complicated by ARDS in a third-trimester healthcare worker.

Miliary tuberculosis (TB) in pregnancy presents unique diagnostic and therapeutic challenges due to overlapping physiological changes, imaging limitations, and fetal considerations. We describe a 42-year-old third-trimester healthcare worker who presented with prolonged fever and rapidly progressive hypoxaemia. Initial investigations were inconclusive, and imaging showed subtle reticulonodular opacities. Her condition worsened into severe ARDS, requiring emergency caesarean delivery and mechanical ventilation. Placental histopathology revealed necrotizing granulomatous inflammation, and fundoscopy identified choroidal tubercles. Mycobacterium tuberculosis was later confirmed on bronchoalveolar lavage. Anti-tubercular therapy and corticosteroids led to gradual clinical recovery and successful extubation. The neonate remained well on follow-up. This case underscores the diagnostic complexity of miliary TB in pregnancy and the value of placental pathology and fundoscopy when conventional tools fall short. With timely intervention and multidisciplinary care, even fulminant presentations can result in favourable maternal and neonatal outcomes.