Severe Fetal Intracranial Hemorrhage: Congenital Cytomegalovirus Infection May Play a Role? A Case Report and Review of Literature

Overview

Journal IDCases

Specialty Infectious Diseases

Date 2021 Jun 30

PMID 34189037

Citations 1

Authors

Letizia Capasso

Clara Coppola

Maria Vendemmia

Serena Salome

Valentina Esposito

Chiara Colinet

Carolina Porfito

Francesco Raimondi

Affiliations

Soon will be listed here.

Abstract

Cytomegalovirus (CMV) is the most common cause of congenital infection, with a wide spectrum of clinical manifestations and different grade of severity. We report the case of a male baby born at term with an early prenatal diagnosis of severe intracranial hemorrhage (ICH), with no other evident risk factors. Urine and blood sample were tested for CMV-DNA, and diagnosis of congenital CMV infection was established. This case describes intracranial hemorrhage as uncommon although possible sign of early fetal CMV infection. Considering that pathogenic factors cannot be defined in 25 % of term neonates with ICH, this case report highlights the importance of CMV screening in pregnant women and in term infants with prenatal ICH of unknown origin.

Citing Articles

Congenital cytomegalovirus infection with brainstem hemorrhage and polymicrogyria: Necropsic and histopathological findings.

Arredondo Montero J, Bronte Anaut M, Caballero Martinez M, Fernandez Seara M, Martin-Calvo N Congenit Anom (Kyoto). 2022; 62(6):248-253.

PMID: 35941838 DOI: 10.1111/cga.12488.

References

Persoons M, Stals F, van Dam Mieras M, Bruggeman C . Multiple organ involvement during experimental cytomegalovirus infection is associated with disseminated vascular pathology. J Pathol. 1998; 184(1):103-9. DOI: 10.1002/(SICI)1096-9896(199801)184:1<103::AID-PATH964>3.0.CO;2-C. View

Giannattasio A, Bruzzese D, Di Costanzo P, Capone E, Romano A, DAmico A . Neuroimaging Profiles and Neurodevelopmental Outcome in Infants With Congenital Cytomegalovirus Infection. Pediatr Infect Dis J. 2018; 37(10):1028-1033. DOI: 10.1097/INF.0000000000001974. View

Kimberlin D, Jester P, Sanchez P, Ahmed A, Arav-Boger R, Michaels M . Valganciclovir for symptomatic congenital cytomegalovirus disease. N Engl J Med. 2015; 372(10):933-43. PMC: 4401811. DOI: 10.1056/NEJMoa1404599. View

Rawlinson W, Boppana S, Fowler K, Kimberlin D, Lazzarotto T, Alain S . Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017; 17(6):e177-e188. DOI: 10.1016/S1473-3099(17)30143-3. View

de Vries L, Gunardi H, Barth P, Bok L, Verboon-Maciolek M, Groenendaal F . The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection. Neuropediatrics. 2004; 35(2):113-9. DOI: 10.1055/s-2004-815833. View

Dallar Y, Tiras U, Catakli T, Gulal G, Sayar Y, Selvar B . Life-threatening intracranial bleeding in a newborn with congenital cytomegalovirus infection: late-onset neonatal hemorrhagic disease. Pediatr Hematol Oncol. 2010; 28(1):78-82. DOI: 10.3109/08880018.2010.513032. View

Suksumek N, Scott J, Chadha R, Yusuf K . Intraventricular hemorrhage and multiple intracranial cysts associated with congenital cytomegalovirus infection. J Clin Microbiol. 2013; 51(7):2466-8. PMC: 3697656. DOI: 10.1128/JCM.00842-13. View

Nigro G, La Torre R, Sali E, Auteri M, Mazzocco M, Maranghi L . Intraventricular haemorrhage in a fetus with cerebral cytomegalovirus infection. Prenat Diagn. 2002; 22(7):558-61. DOI: 10.1002/pd.366. View

Giannattasio A, Di Costanzo P, De Matteis A, Milite P, De Martino D, Bucci L . Outcomes of congenital cytomegalovirus disease following maternal primary and non-primary infection. J Clin Virol. 2017; 96:32-36. DOI: 10.1016/j.jcv.2017.09.006. View

10.

Salome S, Giannattasio A, Malesci R, Marciano E, Dolce P, Portella G . The Natural History of Hearing Disorders in Asymptomatic Congenital Cytomegalovirus Infection. Front Pediatr. 2020; 8:217. PMC: 7214611. DOI: 10.3389/fped.2020.00217. View

11.

Munoz N, Pinzon H, Vizcaino H, Moneriz C . [Cerebrovascular hemorrhage associated with acquired cytomegalovirus infection in an infant]. Biomedica. 2014; 34(4):521-7. DOI: 10.1590/S0120-41572014000400004. View

12.

Moinuddin A, McKinstry R, Martin K, Neil J . Intracranial hemorrhage progressing to porencephaly as a result of congenitally acquired cytomegalovirus infection--an illustrative report. Prenat Diagn. 2003; 23(10):797-800. DOI: 10.1002/pd.688. View

13.

Giannattasio A, Di Costanzo P, Milite P, De Martino D, Capone E, Romano A . Is lenticulostriated vasculopathy an unfavorable prognostic finding in infants with congenital cytomegalovirus infection?. J Clin Virol. 2017; 91:31-35. DOI: 10.1016/j.jcv.2017.04.006. View

14.

Golden M, Hammer S, Wanke C, Albrecht M . Cytomegalovirus vasculitis. Case reports and review of the literature. Medicine (Baltimore). 1994; 73(5):246-55. View

15.

Kirkham F, Zafeiriou D, Howe D, Czarpran P, Harris A, Gunny R . Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging, alloimmune thrombocytopaenia and monochorionic twins. Eur J Paediatr Neurol. 2018; 22(6):989-1005. DOI: 10.1016/j.ejpn.2018.08.008. View