Severe disseminated neonatal tuberculosis: a diagnostic challenge. A case report

Abstract

Neonatal tuberculosis (TB) is an uncommon clinical entity, yet it carries a high mortality rate without timely treatment. The rising incidence of TB in Chile poses a diagnostic challenge in neonates, due to nonspecific symptoms resembling sepsis. We report a clinical case 6-week-old male infant admitted with shock, multi-organ failure, hepatosplenomegaly, and miliary pattern on chest X-ray. Neonatal TB was confirmed by  Xpert® MTB/RIF Ultra testing on tracheal samples, cerebrospinal fluid and stool, as well as by culture from endotracheal and gastric aspirates. An epidemiological link to his mother, who had active pulmonary TB was identified. The patient progressed with severe respiratory compromise, requiring prolonged mechanical ventilation and a tracheostomy. He received intensive antituberculosis therapy for 12 months, adjusted for central nervous system involvement and hepatic adverse reactions. Neonatal TB should be considered in the differential diagnosis of sepsis or refractory pneumonia. A high index of clinical suspicion based on epidemiological history is required, and rapid molecular diagnostic tools should be utilized to reduce morbidity and mortality.