The First Documented Case of Congenital Drug-Resistant Tuberculosis in Indonesia: A Case Report.

Congenital drug-resistant tuberculosis (DR-TB) is a rare condition with no standardized treatment. Congenital TB itself is a life-threatening condition. The clinical manifestations can be nonspecific, particularly in preterm infants, which can further reduce diagnostic awareness. We report a case of a 32-week preterm baby with rifampicin-resistant TB. She was born with respiratory distress and early-onset jaundice, initially suspected of sepsis and admitted to the NICU. The infant initially showed clinical improvement at 3 days of life, but at 23 days of life, the clinical condition worsened despite a sterile blood culture. The mother was subsequently diagnosed with miliary TB with rifampicin-resistant Xpert sputum. The infant's gastric lavage Xpert MTB/RIF confirmed rifampicin-resistant TB. At 32 days of life, she received a five-drug regimen, including bedaquiline. She completed 12 months of treatment with a favourable outcome. This case highlights the challenges of early recognition and treatment selection in congenital DR-TB.