Abstract
BackgroundCytomegalovirus is the most common pathogen causing congenital infection and can result in significant neurodevelopmental adverse outcomes. For this reason, it is the standard of care in many regions to treat congenital cytomegalovirus infection involving the brain with six weeks of ganciclovir. There have been no reports in the published literature of significant cytomegalovirus neonatal infection in infants previously treated for congenital infection.Case presentationA preterm male infant with congenital symptomatic cytomegalovirus infection was initially treated with over 8 weeks of ganciclovir between the ages of 3 and 14 weeks. At four months chronologic age, just prior to planned discharge, he developed an episode of life-threatening multisystem cytomegalovirus disease notable for severe pneumonitis, encephalitis, hepatitis, and disseminated intravascular coagulation. This disease resolved after re-treatment with a prolonged course of intravenous ganciclovir and oral valganciclovir.ConclusionsClinicians should be aware of the possibility of recurrence of congenital cytomegalovirus infection, especially in preterm infants. Serial plasma cytomegalovirus viral load monitoring may have a role in the management of premature infants treated with ganciclovir; had the diagnosis of recrudescent cytomegalovirus infection been considered sooner, specific therapy might have been more quickly initiated and perhaps further morbidity would have been prevented.
Highlights
Cytomegalovirus is the most common pathogen causing congenital infection and can result in significant neurodevelopmental adverse outcomes
Clinicians should be aware of the possibility of recurrence of congenital cytomegalovirus infection, especially in preterm infants
Serial plasma cytomegalovirus viral load monitoring may have a role in the management of premature infants treated with ganciclovir; had the diagnosis of recrudescent cytomegalovirus infection been considered sooner, specific therapy might have been more quickly initiated and perhaps further morbidity would have been prevented
Summary
The clinical presentation and sequelae associated with congenital CMV disease have been described in detail; this is the first reported case of which we are aware to describe an infant treated for congenital CMV infection who later in infancy had a life-threatening episode of presumed multi-organ CMV infection. Our case has potential implications for both diagnostic testing and patient follow-up; had the diagnosis of recrudescent CMV infection been considered sooner, we could have more quickly initiated specific therapy and perhaps reduced morbidity To this end, it may be useful to monitor plasma CMV VL at cessation of therapy, 2–4 weeks later (to catch initial VL rebound), and at the time of any clinical deterioration/systemic illness of uncertain aetiology, especially for babies not born at term. It may be useful to monitor plasma CMV VL at cessation of therapy, 2–4 weeks later (to catch initial VL rebound), and at the time of any clinical deterioration/systemic illness of uncertain aetiology, especially for babies not born at term This case raises the question once again about the appropriate duration of therapy for congenital CMV infection.
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