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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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CYTOMEGALOVIRUS INFECTION IN A INFANT WITH VENTRICULOMEGALY. IS IT CONGENITAL OR POSTNATAL?

Tânia Moreira1, Marta Póvoas2, Rita Silva3, Maria João Brito4, Rita Machado1

1- General Pediatrics Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa;
2- Pediatric Department, Hospital do Espírito Santo, Évora;
3- Pediatric Neurology, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa;
4- Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa

- 32nd Annual Meeting of the European Society for Paediatric Infectious Diseases ESPID 2014, Dublin, 6-10 Maip 2014 (poster)

Introduction: Differential diagnosis between congenital and postnatal cytomegalovirus (CMV) infection may be challenging and essential for follow-up.

Aims: We describe a case of CMV infection that illustrates the difficulty of correct diagnosis.

Methods: Data from patient's hospital file.

Results: A six-week old male infant presenting irritability and progressive feeding difficulties since third week was admitted for splenomegaly, anemia, lymphomonocytosis and thrombocytopenia. Acute CMV infection was diagnosed [IgG+ (240 UA/mL)/IgM+ (1,03), polymerase chain reaction (PCR) positive in urine and blood, negative in cerebrospinal fluid; viral load 535 copies/mL]. Could be congenital infection due to ventriculomegaly detected at 25 weeks of gestation and periventricular calcifications suspected by ultrasound and brain MRI, but calcifications weren't confirmed by CT scan. In favor to postnatal infection we had maternal antibodies for CMV IgG>250 UA/mL, IgM negative, also during second trimester of pregnancy, a newborn assymptomatic at birth and breastfed for the first two weeks, clinical improvement during hospitalization, IgG titers inferior to mother's, IgM and viral load negative at discharge. No treatment was administered.
PCR for CMV-DNA in Guthrie card was negative (known after discharge). Followed at hospital consultations, he's neurologically well with six months old, besides macrocephaly and mild axial hypotonia.

Conclusion: Though some findings were prone to congenital infection, as ventriculomegaly, postnatal infection was supported by CMV maternal serology during pregnancy, no symptoms at birth, breastfeeding, positive PCR for CMV, increased titers of IgM subsequently negative and similar mother/infant CMV IgG ratio. Lately, the diagnosis was confirmed by PCR in Guthrie card.

Palavras Chave: CMV, congénito, pós-natal, ventriculomegália