Congenital tuberculosis is rare in spite of tuberculosis being a common infection worldwide. Due to the nonspecific nature of the presenting signs and symptoms and fatal outcome in absence of early therapy, the importance of early diagnosis is underscored. Young infants with tuberculosis become infected after birth through exposure to family or household members with contagious pulmonary disease. Routes of infection of the fetus before or during birth are dissemination to fetus via the placenta, aspiration of infected amniotic fluid, and direct contact with tuberculous cervicitis or endometritis. We report a case from India of congenital tuberculosis in a 3-month-old male infant who presented with respiratory failure, hepatomegaly, and diffuse infiltrates in the chest radiograph that persisted despite empiric antibacterial therapy. There was no known exposure to tuberculosis by history. Bronchoalveolar lavage culture yielded Mycobacterium tuberculosis. He was successfully treated with quadruple antituberculous medications reinforcing the potential good outcomes with the correct diagnosis.