Patient information: a 26-day-old neonate weighing 2,500 grams was referred by the public health center to the emergency room (ER) of Regional Public Hospital of Agats with complaints of fever, cough, tachypnea, and poor feeding since the age of 21 days old. The history of pregnancy and childbirth from the patient s mother were unclear because she had never done antenatal care during her pregnancy and the delivery was aided by no medical staff.
Clinical findings: the patient was lethargic with a temperature of 37.8 C, a heart rate of 180 beats/minute, a respiratory rate of 64 breaths/minute, and an oxygen saturation of 85% in the room air. Physical examination revealed subcostal retraction, bilateral crackles, hepatomegaly, and signs of shock, such as cold extremities, prolonged capillary refill time, and weak pulse.
Diagnostic assessment: laboratory results indicated a hemoglobin of 13.4 g/dL, leukocytes of 21,260/mm3, platelets of 280,000/mm3, blood sugar of 111 mg/dL, sodium of 136 mmol/L, potassium of 2.5 mmol/L, normal urinalysis, and a negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen swab. The patient was hospitalized with diagnosis of septic shock and neonatal pneumonia. The patient was given broad-spectrum intravenous antibiotics, as well as other supportive medical care. A chest X-ray could not be performed due to a technical problem; therefore, a chest ultrasound was performed as an alternative radiological examination. A chest ultrasound discovered a B-line image. The patient experienced a temporary improvement. Unfortunately, clinical deteriorations happened on the 16th day of care. Due to the respiratory distress continued to worsen, intubation was performed and mechanical ventilator assistance was provided. An acid-fast bacteria (AFB) stain and a rapid molecular test were performed on the endotracheal aspirate. A positive result of AFB stain, which was sensitive to rifampicin, was discovered. Based on these findings, the patient was diagnosed as having perinatal TB. Tuberculosis screening was conducted on the patient s mother with a positive result. Investigation towards the possibility of the human immunodeficiency virus (HIV) showed a negative result on the patient s mother.
Therapeutic interventions: the patient was treated with anti-TB regimens (isoniazid, rifampicin, pyrazinamide, ethambutol), prednisone, along with other supportive medical care.
Follow-up and outcome of interventions: recurrent septic shock, laryngeal edema, and the possibility of ventilator-associated pneumonia (VAP) worsened the patient s condition. The patient eventually passed away on the 71st day of care.
Informed consent: written informed consent was obtained from the patient s mother.