Cytomegalovirus (CMV) is the most common congenitally acquired infection. It is of major concern due to the long-term neurodevelopmental morbidity in both symptomatic and asymptomatic newborns. While CMV infection is less commonly diagnosed in infancy to adulthood, mostly due to its asymptomatic presentation, it is still an important differential to consider. A missed diagnosis could lead to visual impairments and neurological complications. Infants can acquire CMV by encountering bodily secretions from those who have an active infection. Symptoms of infection include fever, fatigue, pharyngitis, and hepatitis. Laboratory abnormalities include thrombocytopenia, elevated transaminases, and abnormal lymphocyte count. We investigated a clinical case of a previously healthy 5-month-old whose only symptoms were petechial rash and thrombocytopenia. They presented to the ED with a worsening petechial rash for 11 days. The patient’s mother had prenatal care and an uncomplicated pregnancy. In the ED IgM for CMV was positive and platelet count on admission was 35K. The patient was discharged without intervention because platelet count remained above 20K. Outpatient hematology workup ruled out other potential causes of thrombocytopenia. There is no family history of bleeding disorders. The patient was prescribed valganciclovir for 2 months and urine CMV PCR was ordered for the patient and the patient’s mother. The patient’s urine CMV was positive, but the mother’s urine CMV was negative. The patient’s petechiae and thrombocytopenia improved while on valganciclovir treatment. In this case, since the patient’s mother was negative for CMV, it is unlikely that the infection was maternally acquired. Our case illustrates that CMV infection in infancy can be acquired through horizontal transmission and its only presentation can be thrombocytopenia. Since the CMV infection was diagnosed early the patient did not have any neurological symptoms, such as sensorineural hearing loss or delayed developmental milestones.
| Identifer | oai:union.ndltd.org:ETSU/oai:dc.etsu.edu:asrf-2124 |
| Date | 25 April 2023 |
| Creators | Keelty, Kylie M, Pham, Alice, Macariola, Demetrio, MD |
| Publisher | Digital Commons @ East Tennessee State University |
| Source Sets | East Tennessee State University |
| Detected Language | English |
| Type | text |
| Source | Appalachian Student Research Forum |
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