Intracranial calcification, microcephaly, and intrauterine growth restriction: a telltale sign of congenital cytomegalovirus infection.

Abstract

A term new born male, born to a 19 year old mother belonging to poor socioeconomic status presented with features of microcephaly and intrauterine growth restriction. Computed tomography of brain was performed which showed multiple fine and coarse foci of calcification along sulci and in periventricular white matter. Blood and urine samples of the baby were sent for DNA polymerase chain reaction analysis of cytomegalovirus (CMV) and were found positive for the same. Mother’s serum was also positive for CMV-IgG antibodies. A diagnosis of congenital CMV infection of the new born was diagnosed. CMV is a ubiquitous virus which generally leads to benign manifestations. People with normal immune status are almost always asymptomatically infected by CMV. However, intrauterine infection with CMV can lead to substantial neurologic sequelae in the form of microcephaly, sensineural hearing loss, chorioretinitis, mental retardation and seizers. The severity and type of damage on developing brain depends on stage of developing nervous system at the time of fetal infection. Imaging findings on ultrasonography and computed tomography include microcephaly, intracranial calcification with periventricular distribution, intrauterine growth restriction, hydrocephalus and abnormal appearing brain parenchyma. Magnetic resonance imaging may reveal additional findings related to neural migration like lissencephaly, pachygyria, microgyria and schizencephaly.