An appropriate-for-gestational age newborn female was delivered at term by elective cesarean section, with good Apgar scores. The infant's initial evaluation was unremarkable. The mother was a healthy 31-year-old African from Liberia with good prenatal care, and the pregnancy was uncomplicated. However, intractable postpartum bleeding led to a hysterectomy, with a diagnosis of retained placenta. The placenta and uterus were examined, with extensive sampling of the placenta, and a diagnosis of placenta accreta was rendered.
The newborn developed fever and leukocytosis in the 1st week of life and she was treated for bacterial sepsis, although all cultures were eventually negative. Her physical examination was unremarkable except for slight hepatomegaly. A TORCH and other viral and malaria studies were negative, but serum immunoglobulin M was 250 mg/dL (normal: up to 25 mg/dL), consistent with a congenital infection. Head imaging was negative, but an eye exam showed chorioretinitis. In the first 3 weeks of life she appeared mildly ill, with lethargy and poor feeding.
At day 20 postpartum, the mother developed a respiratory infection with pleural effusion, and her clinical studies led to the diagnosis of pulmonary TB. On this basis, a similar diagnosis was entertained in the newborn when she developed classic miliary disease in her lungs and hepatosplenomegaly. A purified protein derivative of tuberculin (PPD) skin test showed 6 mm of induration, and a gastric lavage was positive for Mycobacterium tuberculosis. Treatment of the child with Isoniazide, Rifampin, and Streptomycin was administered. Because of persistent liver dysfunction, a liver biopsy was performed. The patient continued to improve, although mild liver dysfunction, mild hypersplenism, and poor weight gain persisted, and was discharged at 2 months of age. At 9 months of age she had improved substantially and had gained weight, and toward her 2nd year of life she had recovered completely, with no residual deficits. Anti-TB therapy was discontinued at 1 year of age.