Tuberculosis congénita: Presentación infrecuente de una enfermedad habitual

La tuberculosis congenita es una forma clinica grave, rapidamente progresiva, que se diferencia de la forma neonatal por aparicion de la lesion en las primeras semanas de vida, presencia de complejo primario hepatico o granulomas caseosos,confirmacion de tuberculosis en la placenta o tracto genital la madre (utero o anexos) y exclusion de exposicion en el canal de parto o post-natal por contacto con foco tuberculoso incluyendoal personal hospitalario. Comunicamos un caso de un recien nacido de 20 dias ingreso a neonatologia por sindrome febril sin foco evidente evoluciono con hepatoesplenomegalia, distension abdominal y dificultad respiratoria. Ecografia abdominal con ascitis, hepatoesplenomegalia difusa, imagenes hipoecoicas en bazoadenopatias adyacentes al tronco celiaco y en hilio hepatico.de torax con infiltrado micronodulillar. Antecedente materno de neumonia con derrame durante el embarazo. Ante la sospecha de tuberculosis congenita comenzo tratamiento empirico con 4 drogas: isoniacida, rifampicina, pirazinamida y etambutol. Fallece al dia siguiente. Se recibio posteriormente desarrollo de M. tuberculosis en cultivo de lavado gastrico, hemocultivoy puncion esplenica Congenital tuberculosis is a severe rapidly progressive disease which differs from neonatal tuberculosis because patients present tuberculous lesions during their first weeks of life, primary hepatic complex or hepatic caseous granulomas, confirmation of tuberculosis in placenta or in maternal genital tract (uterus or adnexa), and exclusion of birth channel or postnatal exposure. We report a case of a 20 days newborn baby admitted to the neonatal unit with fever, hepatoesplenomegaly, abdominal distension and respiratory symptoms. Abdominal echography showed ascitis, diffuse hepatomegaly and splenomegaly, focal hipoecoical spleen images and portal lymphadenopathy. Thorax X-ray with micronodular infiltrates. Maternal pneumonia with pleural effusion was reported during pregnancy. Empirical treatment was initiated with 4 antituberculous drugs: isoniazid, rifampicin, pyrazinamide and ethambutol suspecting tuberculosis. She died the next day. M. tuberculosis was obtained in a gastric lavage culture, blood cultures and post mortem spleen puncture.