Congenital Cytomegalovirus Infection Manifesting as Neonatal Persistent Pulmonary Hypertension: Report of Two Cases

Abstract

Various neonatal symptoms can lead to a diagnosis of congenital CMV infection. We report two cases of persistent pulmonary hypertension in relation with congenital CMV infection following maternal primary infection and reinfection, respectively. Both infants had severe refractory hypoxemia, requiring high-frequency ventilation, inhaled nitric oxide and inotropic support. One of them required extracorporeal membrane oxygenation for five days. Ganciclovir therapy was attempted in the two cases on day 12 postnatal. One of the infant died on day 15 postnatal. The other survived and is developing uneventfully at 15 months of age. Conclusion: Neonatal persistent pulmonary hypertension can be the consequence of congenital CMV infection. Intensive respiratory support and IV ganciclovir are indicated in case of life-threatening condition.

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“…Antiviral agents (eg, ganciclovir) are the recognized treatment modality. [18][19][20] In our patient, cytomegalovirus was isolated at some point in the bronchoalveolar lavage. However, despite ganciclovir treatment, her lung condition did not improve, motivating an open lung biopsy that did not show any evidence of viral inclusions.…”

“…[18][19][20] This can result in a complicated ventilatory course and has been associated with the development of BPD, cystic lung disease, congenital lobar emphysema, and severe pulmonary hypertension. A diagnosis is usually made by isolating the cytomegalovirus in the bronchioloalveolar lavage and urine, and a lung biopsy typically demonstrates viral inclusions in pneumocytes.…”

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“…Neurodevelopment and audibility are normal at age 2 years. (11)(12)(13)(14). We consider that the positive CMV-IgM in the mother and the neonate suggested CMV infection occur in later pregnancy, and this factor might contribute that the neonate have congenital CMV infection with mild respiratory distress.…”

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