DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.041

Pages: 2297-2301

Background. Congenital tuberculosis (TB) is a rare and frequently fatal form of TB. Its nonspecific presentation and a low index of suspicion lead to frequent misdiagnosis and diagnostic delay. Diagnosis relies on the Cantwell criteria, and the maternal source is often unrecognised at the time the infant presents. Case presentation. A one-month-old infant, born at term after an uneventful pregnancy and exclusively breastfed, presented with a five-day history of fever and progressive abdominal distension. Examination showed gross abdominal distension with an everted umbilicus and marked hepatosplenomegaly, while the general condition was preserved. Laboratory work-up revealed a markedly elevated C-reactive protein with repeatedly sterile blood and urine cultures, and negative TORCH, HIV, metabolic and tumoral screening. Thoraco-abdomino-pelvic computed tomography demonstrated a miliary pulmonary pattern, necrotic mediastinal and abdominal lymphadenopathy, and micronodular hepatic, splenic and renal lesions. Percutaneous liver biopsy showed epithelioid and giant-cell granulomas with caseous necrosis, establishing caseating tuberculosis. As caseating hepatic granulomas satisfy the Cantwell criteria, congenital TB was diagnosed. Antituberculous quadritherapy was started; cerebral CT and cerebrospinal fluid analysis were normal. Maternal evaluation was initially unremarkable but the QuantiFERON test was positive; one month later the mother developed tuberculous meningitis. The infant's illness thus revealed previously latent maternal infection. Conclusions. Congenital TB should be considered in any neonate or young infant with unexplained fever, hepatosplenomegaly and an antibiotic-unresponsive sepsis-like illness. Liver biopsy demonstrating caseating granulomas is diagnostic under the Cantwell criteria, and systematic maternal investigation is essential: the infant may be the sentinel case that reveals maternal disease.