The presentation of congenital tuberculosis (TB) is varied, with frequent extrapulmonary disease, but congenital spinal TB has been rarely reported. We present 2 cases of spinal TB (1 confirmed, 1 clinical diagnosis) in HIV-exposed infants with likely congenital transmission. Increased vigilance for congenital TB, including uncommon presentations, is needed, particularly in countries with high HIV and TB prevalence.
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