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Tuberculosis has re-emerged as a serious health concern as a result of AIDS epidemic, immigration from areas where the disease is endemic and multi drug resistance, with 8.8 million patients affected worldwide in 2010. Infections with mycobacterium tuberculosis (MTb) are globally prevalent in many countries, yet descriptions of placental pathology in tuberculous patients are few. Moreover, the diagnosis of tuberculosis in pregnant patients can be missed or delayed owing to the insidious onset and variability of clinical presentation, often overlapping with non-specific symptoms common in pregnancy such as loss of appetite, malaise and lethargy. The exact incidence of tuberculosis in pregnancy is not readily available in many countries due to confounding factors. However, it is expected that the incidence of tuberculosis in pregnant women is high as in general population, with higher incidence in developing countries. Placental tuberculosis shows predominantly neutrophilic and histiocytic response in the form of villitis and intervillitis which is due to the innate immune response. This innate response contributes more to tissue injury than protection as proved in our case, where it led to intrauterine death of the fetus. We, hereby report a case of placental tuberculosis, diagnosed on histopathological examination of placenta showing caseating epithelioid cell granulomas with langhan’s giant cells and Acid Fast Bacilli on Zeihl Neilson stain.

Background: Greater and lesser occipital neuralgias are primary neuralgias that are relatively uncommon, where the pain is felt in the distribution of these nerves. Objective: This review paper was intended to describe the features and management of occipital neuralgia in the context of a challenging case. Material and Methods: We looked at succinct literature from the past 30 years. We compared the features of our challenging case given in the current literature. In addition, an overview of the current literature is provided. Results: The case, although proved to be a diagnostic challenge, we were able to reach a conclusion and render the patient almost complete pain relief by conservative management modalities. It proved to be a rare presentation of occipital neuralgia with unusual pain distribution, and we are able to describe a literature-based explanation for this entity to be a diagnostic and management challenge. Conclusion: Primary headaches, i'n general, are a group of headache disorders that require exquisite diagnostic skills. The clinical history is a key factor when making an accurate diagnosis, and to establish an appropriate management plan.

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