![]() ![]() The patient was admitted to the neonatal intensive care unit, and treatment, along with diagnostic workup for possible immunodeficiency, was continued. ![]() Intravitreal injection of ganciclovir (1 mg/0.1 cc) was performed twice a week in both eyes, three injection in each one ( Fig. 2 A & B). Therefore, bilateral CMVR, which was probably transmitted from the mother within the final days of pregnancy, was diagnosed in this healthy infant.Īccordingly, intravenous ganciclovir (10 mg/kg/day) was commenced. antigen pp 65) was not evaluated for his mother. ![]() Lab tests were performed to rule out immunodeficiency in the mother, the results of which were inconclusive except for the serologic tests which revealed positive immunoglobulin G (IgG) for CMV with negative IgM (seroconversion). CMV DNA was detected in the patient's ocular sample and cerebrospinal fluid (CSF) (via PCR). The results of systemic workup and laboratory tests evaluating the immune system were normal, except for CMV infection. Intravitreal ganciclovir (1 mg/0.1 cc) was injected in the right eye at the same time. With a suspicion of infectious retinitis (especially CMVR), a sample of the anterior chamber was used for polymerase chain reaction (PCR) assay of herpes simplex virus (HSV), varicella-zoster virus (VZV), CMV, and toxoplasmosis. The mother was presumed immunocompetent without any remarkable past medical history. However, the mother had a previous history of fever and malaise in the eighth month of pregnancy, which remained undiagnosed. Prenatal and 1st trimester screening tests were normal with negative CMV serology. The patient's history of medical and ocular conditions was unremarkable. The last RetCam fundus photography discloses no significant change in the right (A) and the left eyes (B) after treatment. Herein, we present the case of a healthy, full-term infant, who presented with CMVR and died due to the involvement of the central nervous system (CNS). 7, 8 Surprisingly, CMVR has been detected in individuals without any evidence of immunodeficiency. Moreover, this infection has been reported in patients undergoing bone marrow transplants and chemotherapy. 4, 5, 6 Besides AIDS and human immunodeficiency virus (HIV), other immunosuppressive conditions such as severe combined immunodeficiency are associated with CMVR in children. 3ĬMVR is mainly associated with acquired immunodeficiency syndrome (AIDS). 2 This infection, in terms of neonates, is usually asymptomatic, whereas in premature or immunocompromised infants, can lead to a broad spectrum of symptoms, including life-threatening conditions. Postnatal CMV infection can be transmitted through vaginal secretions, contact with infected individuals, blood transfusion, or breast milk which is the most common route of transmission. 1 CMV retinitis (CMVR) is less common among children than adults.ĬMV infection could be either a congenital or an acquired infection in the postnatal period. The incidence of this infection is speculated to rise to 5% of seropositive newborns in developing countries. Cytomegalovirus (CMV) infection is the most common congenital infection around the world, affecting 1% of live births in the United States. ![]()
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