Congenital tuberculosis: A diagnosis delayed in a child with atrial septal defect

Congenital tuberculosis (CTB) is a rare disease presenting in infants with very few cases reported despite a high burden of tuberculosis. The fewer reported cases reflect in part the difficulty in making a definitive clinical diagnosis as signs and symptoms are non- specific along with difficult laboratory confirmation due to several reasons. We report a case of 4-month-old male child presenting with fever and cough for 3 months and respiratory distress and feeding difficulties for 5 days with no response to antibiotics. Systemic examination revealed bilateral crepitations, pansystolic murmur, and hepatosplenomegaly. Echocardiography revealed an 8 mm atrial septal defect. The patient did not respond to decongestive therapy. Ultrasonography revealed an enlarged liver with a 12 cm liver span. Liver biopsy showed necrotizing epithelioid cell granuloma. Based on the Cantwell's criteria, the diagnosis of CTB was proffered.