The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Congenital Cytomegalovirus Infection

A B

A
35-year-old woman presented to the obstetrical clinic for Kenta Kawai, M.D.
routine fetal ultrasonography at 24 weeks of gestation. Her medical history Hiroaki Itoh, M.D., D.Med.Sci.
was notable for a febrile illness that had occurred shortly after conception. Hamamatsu University School of Medicine
Ultrasonographic images showed ventricular dilatation in the fetal brain, and Hamamatsu, Japan
T2-weighted magnetic resonance imaging revealed ventriculomegaly (Panel A) d15018@hama-med.ac.jp
and cerebellar hypoplasia. Maternal serum immunoassay was positive for cyto-
megalovirus (CMV) IgG and IgM antibodies. At 38 weeks of gestation, the woman
had a normal vaginal delivery of a male baby weighing 2556 g (8th percentile) with
a head circumference of 30.5 cm (1st percentile). Petechiae were observed on the
newborn’s face and trunk. Laboratory evaluation revealed a platelet count of
136,000 per cubic millimeter (reference range, 150,000 to 450,000) and normal
hematocrit and aminotransferase levels. Computed tomographic scans of the new-
born’s brain showed ventricular dilatation, parenchymal hypoplasia with polymicro-
gyria, and periventricular calcifications (Panel B, arrows). Immunohistochemical
testing of the placenta was positive for CMV, and polymerase-chain-reaction test-
ing of the newborn’s urine revealed CMV DNA — findings that confirmed con-
genital CMV infection. Congenital CMV infection can be asymptomatic, or symp-
toms can include growth restriction, hematologic disorders, and sensorineural
developmental disorders that range in severity from mild to severe. The newborn
was treated with ganciclovir. At a follow-up visit at 11 months of age, the child
had sensorineural hearing loss in the right ear, epilepsy, spastic quadriparesis, and
developmental delay; treatment included antiepileptic medication and developmen-
tal services.
DOI: 10.1056/NEJMicm1800262
Copyright © 2018 Massachusetts Medical Society.

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