Background: Tuberculosis is a menace facing developing world. In India it is not unusual for pregnant women to get affected by tuberculosis. Since many of these pregnant women are asymptomatic or have non-specific symptoms the diagnosis is often delayed or even missed. An infected mother may transmit the infection to the fetus causing congenital tuberculosis which is even more challenging to diagnose not only because of its rarity but also due to non-specific signs and symptoms in neonate. We present here a case of A 37 days old infant who presented with respiratory distress, hepatosplenomegaly and refusal to feed.

Case Report: A 37 days old infant presented with high spikes of fever, cough and refusal for feeds for past 15 days and had no response to antibiotics. He was not immunized. On examination infant was having hepatosplenomegaly and respiratory distress. On auscultation bilateral crepitations were present. On computed tomography extensive nodules in bilateral lung parenchyma with extensive mediastinal and bilateral hilar lymphadenopathy. In view of imaging features and the fact that the child didn’t respond to IV antibiotics a diagnosis of Koch’s was considered and investigations were done. Diagnosis of Koch’s was confirmed on the basis of investigations such as gastric aspirate for AFB, M. Tuberculosis DNA-GeneXpert and by polymerase chain reaction (PCR).

Conclusion: The diagnosis of congenital tuberculosis requires a high index of suspicion and thorough evaluation of both mother and infant. Because of non-specific symptomatology in neonates the diagnosis may be delayed leading to complications.

Keywords: Neonatal tuberculosis, Imaging, Diagnosis, Management.

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Dr Kajal Prakash

Resident Radiologist, Department of Radiology, Sagar hospitals Bangalore, India