Dr.Subbulakshmi P S, Dr.Jayasree.C, Dr.Jayakumar.C
AIMS, Kochi
Ba with Intra cranial calcification
DrSubbulekshmi ,DrJayasree ,DrC Jayakumar
34 week old gestational age ba born LSCS due to fetal distress cried only after resuscitation and later developed respiratory distress ,reached AIMS with neo puff support
Ba was kept NPO initially to start oral feeds a day later and was managed with CPAP and distress improved
Weight of the ba was 1.25kg with head circumference of 27cm and ba had skin rashes all over the body?(Bluberry muffin)
Clinical exam revealed significant hepatomegaly and splenonegaly
Child had an anti-natal sonogram which showed ventriculomegaly with calcification in periventricular areas
CMV IgM was high
Quantitative CMV PCR for the ba was very high 30120098.1 (normal value <60copies )and maternal CMV IgG was also high.Retina of the ba showed no choreioretinitis .Ba had a very small ductus but the heart was otherwise normal
Neuro sonogram revealed dilated bilateral ventricles, periventricular calcification and a bleed along the Caudothalamic groove.
EEG was normal
Inj Ganciclovir was started at-a dose of 6mg /kg/dose as BD and the child developed pan cytopenia which was managed with G CSF (granulate colony stimulating factor)and multiple PRBC transfusion
Child had Aciento bacter sepsis with normal CSF and managed with Ceaperazone Sulbactum and the child improved .
Ganciclovir was advised to continue for 6 weeks,But due to financial reasons Child was discharged
Child had generalised hypotonia at the time of discharge
Sagittal view of the cranial ultrasound showing ventricular enlargement and thalamic calcifications (red arrow).
Discussion –CMV in newborn babies is mostly vertically transmitted and these babies are symptomatic soon after birth. It may be prudent to do CROTCHESscreen (cyto megalovirys ,Rubella others like Toxo,Herpes and syphylis )in-addition to pre op serology which covers only HIV,HEP-B and HEP-C.The most common features seen in congenital CMV are microcephaly, intracranial calcifications, ventriculomegaly, seizures, hypotonia, jaundice, hepatosplenomegaly, hearing loss, chorioretinitis, petechiae, purpura and blueberry muffin rash and all features need not be present for the clinical diagnosis of congenital CMV.
Take home message- CMV infection can be asymptomatic in adults and this case scenario enlightens the significance of antenatal TORCH screening in pregnant mothers. It is also important to manage these mothers in subsequent pregnancies as risk of recurrence is high
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