Congenital Tuberculous Lymphadenitis in a Preterm Neonate Born to a Comatose Mother in a High TB-Burden Setting: A...

Congenital tuberculosis (TB) is a rare but often fatal condition, particularly in preterm neonates within high-burden regions like the Democratic Republic of Congo (DRC). Diagnosis is complicated by nonspecific symptoms and resource limitations, with maternal critical illness further delaying detection and increasing vertical transmission risk.

This case report details a preterm male infant (30 weeks' gestation) born vaginally to an HIV-negative mother who experienced a 2-month coma during pregnancy in the DRC. The neonate presented at 3 weeks with cervical lymphadenopathy, respiratory distress, and failure to thrive. Initial sepsis treatment with antibiotics failed. Postpartum maternal sputum testing confirmed pulmonary TB. Neonatal lymph node biopsy revealed caseating granulomas, and GeneXpert MTB/RIF confirmed Mycobacterium tuberculosis infection. The infant received weight-adjusted antitubercular therapy (rifampicin, isoniazid, and pyrazinamide), leading to progressive clinical improvement.

This case underscores congenital TB as a critical differential diagnosis in preterm infants with lymphadenopathy born to critically ill mothers in TB-endemic areas. Maternal coma-a likely indicator of disseminated TB-masked symptoms, delayed diagnosis, and amplified transmission risk. The report advocates for integrating routine TB screening into antenatal care protocols for all critically ill pregnant women in high-burden settings, irrespective of overt respiratory symptoms. Early maternal diagnosis and prompt neonatal treatment are essential to reduce mortality in this vulnerable population. Enhanced screening in high-risk pregnancies represents an urgent public health priority for mitigating vertical TB transmission in resource-limited contexts.