Congenital Cytomegalovirus Infection and Tetralogy of Fallot: An Unusual Association in a Three-month-old Baby

Abstract

Congenital cytomegalovirus (cCMV) infection is the leading cause of infant morbidity and mortality worldwide. Despite being associated with significant neurological sequelae in infected infants, it remains an under-recognized public health entity. Symptomatic newborns most frequently display hepatosplenomegaly, petechiae, jaundice, microcephaly, intrauterine growth restriction, chorioretinitis, purpura, and seizures. Progressive sensorineural hearing loss is the most prominent adverse outcome of both symptomatic and asymptomatic CMV infections in infants. We report the case of a three-month-old baby who presented with complaints of progressive jaundice for three months and a two days history of fever associated with one episode of fits. The baby was diagnosed with congenital CMV infection on the basis of positive CMV IgM and IgG and positive maternal serum CMV IgG. Finding a murmur on physical examination prompted echocardiography which revealed Tetralogy of Fallot (TOF). The child was managed with a 6-week course of ganciclovir after which his symptoms improved and he was referred to cardiology for the evaluation of his heart defect. Follow-ups at the clinic have shown normal growth and development. This is the first reported association of cCMV infection with TOF. This case highlights the need to consider the possibility of the presence of heart defects in all infants with cCMV infection in addition to neurodevelopmental abnormalities. Clinicians should maintain a high degree of suspicion for cCMV infection in all neonates to ensure timely intervention and to prevent long-term neurological sequelae.

Growth and development of children under 5 years of age with tetralogy of Fallot in a Chinese population

“…In our study, body height was more affected in children with TOF. It has been reported that TOF affects body height severer than acyanotic CHD, might be due to the long period of hypoxemia 19 . The four defects caused by TOF results in short of blood in lung to get oxygen, and oxygen-poor blood effects the metabolic in body tissues, finally leads to the defects of growth and development.…”

"Congenital CMV Infection and Congenitally Corrected Transposition of Great Artery (CCTGA): an Unusual Association"

“…In most cases it is associated with another heart lesion and clinical presentation is dependent on the associated lesions. In patient with no associated lesion, presentation is usually in adulthood with RV dysfunction and heart failure [4].…”