Congenital tuberculosis presenting as acute cervical lymphadenitis in a 28-week preterm infant

Congenital tuberculosis is a rare infection in infants with extremely low birthweight. We report the case of an infant born at 28 weeks' gestation who developed isolated, cervical lymphadenitis at age 84 days. Despite the infant's continuous hospitalisation in the neonatal intensive care unit and a negative maternal history, Mycobacterium tuberculosis was identified through culture and molecular testing of surgical drainage fluid. The diagnosis was substantially delayed due to several factors: a low index of clinical suspicion based on the infant's isolation from external sources, the presence of concurrent cytomegalovirus infection, and the masking effect of empirical linezolid therapy. A review of 20 case reports suggests a recurrent pattern of association between maternal urogenital or endometrial tuberculosis and localised neonatal infection in the head and neck. Congenital tuberculosis in extremely preterm infants can present atypically as late-onset, localised suppuration. To avoid diagnostic delays in the neonatal intensive care unit, clinicians should consider tuberculosis disease when managing localised, antibiotic-refractory infections. Particularly following in-vitro fertilisation, such clinical presentations should prompt an immediate evaluation for occult maternal pelvic tuberculosis.