Cutaneous Tuberculosis in a 22-Day-Old Neonate:A Diagnostic Challenge and Case Report.

BACKGROUND: Cutaneous tuberculosis (CTB) is a rare extrapulmonary manifestation of tuberculosis, particularly in neonates. Its diagnosis is often challenging due to non-specific presentations that can mimic common conditions. CLINICAL DESCRIPTION: We report the case of a 22-day-old male neonate who presented to the emergency room with fever and a scalp swelling following a reported fall from bed. Initial assessment suggested a subcutaneous abscess. The patient did not respond to multiple courses of intravenous antibiotics. A blood culture grew Burkholderia species, but targeted therapy also failed. Incision and drainage were performed, and pus GeneXpert testing was positive for Mycobacterium tuberculosis, despite a negative tuberculin skin test and clear chest X-ray. A final diagnosis of cutaneous tuberculosis (tuberculous chancre) was established. MANAGEMENT & OUTCOME: Anti-tuberculosis therapy (ATT) was initiated, leading to the complete resolution of the swelling and full recovery. CONCLUSION: This case underscores the diagnostic challenges of neonatal CTB. It highlights the importance of considering tuberculosis in the differential diagnosis of non-resolving abscesses in infants, especially in endemic areas, and demonstrates the critical role of molecular diagnostics like GeneXpert in achieving a timely diagnosis.