Metagenomic diagnosis of congenital tuberculosis with coinfections in an extremely preterm infant conceived via in vitro fertilization.

We describe a case of congenital tuberculosis in an extremely preterm infant (24 weeks' gestation, 800 g) conceived via in vitro fertilization, complicated by cytomegalovirus and Klebsiella pneumoniae coinfections. Diagnosis was confirmed by metagenomic next-generation sequencing after conventional tests were inconclusive. Management included anti-tuberculosis, antiviral, and antibacterial therapy, as well as surgical correction of a patent ductus arteriosus. The infant demonstrated significant clinical recovery, with resolution of pulmonary, splenic, and cardiac abnormalities. This case underscores the value of advanced molecular diagnostics and multidisciplinary care in managing life-threatening neonatal infections.