Madhan Kumar Palani, MD
McGill University, Montreal, QC
The patient is a two-month-old baby born preterm at 33 weeks GA. His past medical history is significant for long QT syndrome on propanolol and metatarsus adductus of the left foot. At two months of chronological age, the patient presented with increased work breathing, poor feeding and lethargy for seven days, without fever. He deteriorated rapidly, requiring admission to PICU and intubation and ventilation. CT imaging was consistent with a miliary pattern and ETT culture, as well as induced sputum, were AFB and TB PCR positive. Given the fulminant presentation, steroids were added to HRZE quadruple therapy for TB. The patient rapidly improved and was extubated. The clinical course was complicated by IRIS thought to be secondary to rapid steroid weaning. Given the patient’s young age, a search for an index case was undertaken. His mother underwent an endometrial biopsy revealing necrotizing granuloma and PCR for TB was positive making a diagnosis of congenital TB.
Learning Objectives:
At the end of this presentation, attendees will be able to:
- Know that, even though rare, congenital tuberculosis should be considered in the differential diagnosis of neonatal pneumonia with unknown etiology; and
- Know that, in most cases, proving congenital tuberculosis is very difficult.
