Congenital tuberculosis with possible placental transmission and paradoxical reaction to anti-tuberculosis treatment

Congenital tuberculosis (CTB) is a rare disease with a high mortality rate, requiring high index of suspicion to diagnose because of non-specific presentation. This report describes a case of 6 month male child with congenital tuberculosis with possible placental transmission. Infant had fever, fast breathing and cough since 20 days of life. Ultrasonography (USG) abdomen showed granulomatous lesions in liver. Although mother was diagnosed to be having tuberculosis during 3rd week after delivery and started on anti-tuberculosis treatment (ATT), child remained undiagnosed for 6 months and didn’t get appropriate treatment. Fever, respiratory distress and cough initially improved after starting ATT but patient worsened after 2 weeks of ATT which could not be attributed to cause other than tuberculosis paradoxical reaction (TB-PR). Patient was given steroid following which he gradually improved. This case highlights the importance of keeping high index of suspicion for congenital TB in infants, especially in developing nations, and need for early diagnosis and treatment for the survival of theses infants. PR should be considered even in infancy if patient shows worsening of symptoms after initial improvement that couldn’t be explained otherwise. Correspondence to: Lokesh Tiwari, Assistant Professor of Pediatrics, All India Institute of Medical Sciences Patna, India, Tel: +919631638095; Email: [email protected].