Congenital Tuberculosis in a 2-Week-Old Neonate With an Asymptomatic Mother

Congenital tuberculosis (TB) is a rare condition, and diagnosis is challenging due to its nonspecific clinical presentation and rarity. It has a very high case-fatality rate (estimated at 30%-50%). We report the case of a 2-week-old male neonate, born from an uncomplicated diamniotic, dichorionic twin pregnancy at 36 weeks 1 day's gestation, who presented with poor feeding and low-grade fever. Blood, urine, and cerebrospinal fluid (CSF) cultures, as well as nasopharyngeal and CSF viral polymerase chain reactions were negative. However, persistent poor feeding and rising inflammatory markers prompted continued hospitalization. On the fourth day of admission, he developed acute hypoxemic, hypercarbic respiratory failure with apneas and progressive lung parenchymal disease requiring intubation. The diagnosis of congenital TB was confirmed through endotracheal aspirates. He was initiated on TB treatment but ultimately developed a paradoxical reaction, requiring readmission and initiation of corticosteroids. His mother, father, and twin brother were initially asymptomatic. His twin was subsequently admitted to the hospital and was diagnosed with congenital TB as well. His mother was ultimately diagnosed with genitourinary TB based on an endometrial biopsy. This case contributes to the limited literature on congenital TB, highlighting the broad clinical spectrum and complications in managing the disease. Additionally, the unique presentation of disseminated congenital TB in an infant with an asymptomatic mother and a fraternal twin who initially did not require hospitalization underscores the importance of heightened awareness of tuberculosis during pregnancy, particularly in populations at risk, to facilitate early diagnosis and prevent perinatal transmission.