Congenital tuberculosis presenting with erythema nodosum: a case report

Erythema nodosum is an entity with a relatively low incidence of 1 to 5 per 100,000 live births. The condition is relatively uncommon in prepubertal children and exceptionally rare before 2 years of age. In the paediatric age group, both sexes are equally affected. Although uncommon in children, it remains the most frequent form of panniculitis in paediatrics for which the diagnosis is almost always clinical. The most common cause in children is streptococcal pharyngitis.The association of erythema nodosum with tuberculosis is well known in endemic areas and must always be excluded.  All children with erythema nodosum should be stratified by risk for tuberculosis exposure. Congenital tuberculosis is an unusual and severe clinical presentation of tuberculosis infection. It is rare, even where tuberculosis is endemic. Timely administration of standard antitubercular treatment results in a good outcome.

We report a two-month-old male infant who presented with fever, lethargy, dyspnea, and refusal to feed and whose mother was diagnosed as probable multidrug-resistant tuberculosis. Our patient emphasizes the importance of maternal history, typical skin lesions, and histopathological study in order to approach a definitive diagnosis and institute timely administration of antitubercular drugs.