A Rare Battle: Congenital Tuberculosis in a Late Preterm Neonate Born at 34 Weeks

Abstract Introduction: Congenital tuberculosis (TB) is an uncommon condition, often linked to maternal TB endometritis or disseminated TB. It can be transmitted to the fetus either through the placenta via the umbilical vein or by the fetus aspirating infected amniotic fluid. Case Summary: We present the case of a late preterm infant born at 34 weeks of gestation via vaginal delivery. The mother tested positive for group B streptococcus (GBS) on a vaginal swab, and the baby was admitted to the neonatal intensive care unit (NICU) for 3 days. During this time, he received supplemental oxygen via nasal cannula for 1 day and antibiotics until negative culture results allowed for their discontinuation. At 3 weeks of age, the infant presented to the emergency department with a history of fever, cough, nasal congestion, and reduced oral intake. Notably, the cough was severe enough to cause transient cyanosis. On examination, the infant was hypoxemic and required 1 liter of oxygen via nasal cannula, which was weaned to room air over 3 days. Bilateral crackles were noted on lung auscultation. The infant's mother was recently diagnosed with active pulmonary TB, raising the clinical suspicion of congenital transmission. Two gastric aspirates from the infant tested positive for acid-fast bacilli (AFB), and TB PCR confirmed the diagnosis. A chest X-ray showed extensive perihilar and retrocardiac peribranchial wall thickening with multi-lobar infiltrates, leading to hospital admission. The infant was started on oral anti-TB therapy, which included rifampicin, isoniazid, pyrazinamide, and pyridoxine. Subsequent TB cultures confirmed the sensitivity of the strain. Abdominal ultrasound results were normal, and echocardiography revealed a small patent ductus arteriosus (PDA) with a left-to-right shunt. After two weeks of treatment, repeat gastric aspirates were negative for AFB and TB PCR, indicating good response to the treatment. The infant was discharged with plans for follow-up in infectious disease and cardiology clinics. Conclusion: This case highlights the importance of maintaining a high level of clinical suspicion for congenital TB, particularly in neonates with a relevant maternal history. Early diagnosis and prompt treatment are essential to prevent severe outcomes. Recognizing the subtle presentation of congenital TB in newborns is crucial for timely intervention and improved prognosis.