First-Day Direct Hyperbillirubinemia in an Infant with Congenital Cytomegalovirus Infection

The human cytomegalovirus (CMV) is widely distributed among the human population as one of the most common causes of congenital infection with an incidence of about 0.15-2.0% in developed countries.In this case report we present a female neonate (with a maternal history of flu-like syndrome in 30 weeks of pregnancy) delivered via caesarian section with good reflexes and appropriate APGAR score, without any obvious anomalies. Its cerebrospinal fluid and unigrams were found to be normal. The CMV diagnosis was confirmed by neonate serology (IgM-positive). Additionally, positive results for CMV were obtained from the neonate’s urine polymerase chain reaction test. Therefore, the necessity for differential diagnosis (e.g. hemolysis, ABO RH mismatch, biliary duct obstruction) was eliminated. Treatment with ganciclovir and granulocyte-colony stimulating factor (Gancyclovir induced neutropenia) was provided, as a result of which a dramatic immediate and short-term response was observed.It is proposed that multisystem involvement in congenital CMV should be suspected and medical treatment should be administered especially in life threatening conditions. 

Keywords:

Cytomegalovirus , Early Direct Hyperbilirubinemia , Gancyclovir