Congenital Chylothorax with Cytomegalovirus Positivity: An Etiological Dilemma in a Neonate with Non-Immune Hydrops Fetalis

Abstract

Background: Nonimmune hydrops fetalis (NIHF) due to congenital chylothorax (CC) is rare and is usually associated with high mortality. Chylothorax complicated with congenital cytomegalovirus (CMV) infection is extremely rare and the management becomes challenging. We present a case of CC in a preterm infant with associated CMV positivity, which was managed successfully. Clinical Description: A 2.25 kg, 34-week female newborn, with antenatally diagnosed hydrops, delivered by emergency cesarean section, presented with pleural effusion and poor respiratory efforts. Management: The baby was provided mechanical ventilation and all supportive treatments. Pleural fluid testing was suggestive of high proteins with high white cell counts, predominantly lymphocytes. Baby was also positive for CMV immunoglobulin M with a high number of copies in the urine polymerase chain reaction. The baby initially responded well to oral valgancyclovir but returned with severe respiratory distress on day 20 of life, at which time, was again found to have right-sided chylothorax. This was managed successfully with octreotide at a dose of 8 μg/kg/hour and 90% medium chain triglyceride diet. Conclusions: CC should be considered in the differential diagnosis of NIHF. An incidental serological test positivity for CMV may be superimposed on underlying CC. If the latter is managed optimally with close monitoring, the outcome is usually favorable.