Abstract
<title>Abstract</title> <p>Background : Neonatal tuberculosis (TB) is a rare but potentially fatal disease with nonspecific clinical manifestations, often resulting in delayed diagnosis. The diagnosis is particularly challenging in neonates who present with symptoms despite extensive household exposure to infectious tuberculosis cases. Case Presentation: A 26 day old male neonate born at 39 weeks of gestation with a birth weight of 3,000 g was referred from a community health post due to malnutrition, a severe cough and progressive weight loss. At presentation, the infant weighed 2,200 g, representing an 800 g reduction from birth weight. The infant had a severe cough but no fever. Physical examination revealed an irritable infant with poor oral intake. Vital signs showed a body temperature of 37.6°C, respiratory rate of 70 breaths/min, heart rate of 170 beats/min, and oxygen saturation of 92% on room air. Chest examination demonstrated tachypnea with intercostal retractions and bilateral inspiratory crackles, while wheezing was absent. Laboratory examination revealed leukocytosis with a white blood cell count of 13,000/mm³. tuberculin test and chest radiograph show suggestive positive tuberculosis, The diagnosis was considered based on the Indonesian Pediatric Tuberculosis Scoring System. The grandfather, who lived in the same household, had tuberculous pleural effusion, while four siblings were diagnosed with active pulmonary tuberculosis. All siblings also suffered from malnutrition. Tuberculin skin testing was positive. Based on the epidemiological history, malnutrition, positive tuberculin test, chest radiograph and exclusion of other causes, a diagnosis of neonatal pulmonary tuberculosis associated with malnutrition was established. The patient received isoniazid 10 mg/kg/day, rifampicin 15 mg/kg/day, and pyrazinamide 35 mg/kg/day. After two months of treatment, body weight increased by 1 kg with significant clinical improvement. Conclusion: This case illustrates the complexity of diagnosing neonatal tuberculosis when microbiological confirmation is unavailable. The diagnosis was considered based on the Indonesian Pediatric Tuberculosis Scoring System and After two months of anti-tuberculosis therapy combined with nutritional rehabilitation, the infant showed significant clinical improvement and weight gain.</p>