Case 1: Intracranial Calcifications Associated with Hepatosplenomegaly and Thrombocytopenia.

Abstract

A 2.4-kg female is delivered at 37 weeks and 5 days of gestation via primary cesarean section at a community hospital to a 32-year-old gravida 1, para 0 woman because of decreased fetal movement and a low biophysical profile score. The pregnancy was complicated by herpes zoster virus (HZV) infection in the late first trimester, nonprimary herpes simplex virus (HSV) infection treated with suppression therapy, and gestational diabetes mellitus controlled with insulin. Early ultrasonography showed a cystic hygroma that resolved by 21 weeks’ gestation. Findings on fetal echocardiography and genetic testing are normal. The delivery is unremarkable, and the neonate’s Apgar scores are 8 and 8 at 1 and 5 minutes, respectively. The initial examination findings are remarkable for petechiae on the forehead, microcephaly, hepatosplenomegaly, and a heart murmur. As increasing petechiae spontaneously appear, the neonate develops respiratory distress and hypoxemia, for which she is started on nasal continuous positive airway pressure. Initial complete blood cell count and differential are notable for white blood cells of 49,000/μL (49×109/L) with a lymphocyte predominance and platelets of 16×103/μL (16×109/L). Chest radiography shows a prominent cardiothymic silhouette and low lung volumes but no focal airspace disease. Because of her need for respiratory support and severe thrombocytopenia, she is transferred to our tertiary referral NICU. Upon admission, she undergoes intubation and is given surfactant but demonstrates no improvement. Echocardiography performed on …