Congenital brucellosis in a newborn: A rare case report and clinical insights

Brucellosis is a zoonotic disease with significant global health implications, particularly in endemic regions such as Saudi Arabia. It is characterized by clinical manifestations that mimic both infectious and noninfectious diseases, making diagnosis challenging. Congenital brucellosis, a rare entity, can be transmitted transplacentally from a bacteremic mother or through exposure to maternal secretions during delivery. This report describes the case of a neonate with extremely low birth weight and severe respiratory distress syndrome, who was ultimately diagnosed with congenital brucellosis caused by <i>Brucella melitensis</i>. Despite treatment with trimethoprim-sulfamethoxazole (TMP/SMX) and rifampin, the infant developed abdominal distension and hypotension, showed a clinical picture consistent with sepsis, and succumbed on day 28 of life. This report underscores the importance of early recognition and management of congenital brucellosis to improve outcomes and highlights gaps in antenatal screening and preventive strategies. Diagnosis was confirmed by isolating <i>B. melitensis</i> from blood culture using standard microbiological methods. The patient was treated with trimethoprim-sulfamethoxazole (8 mg/kg/day) and rifampin (10 mg/kg/day). Clinical signs such as persistent hypoxemia and abdominal distension developed before death on day 28. Antenatal screening gaps in endemic regions such as Saudi Arabia contributed to delayed diagnosis.