A male premature infant was born at 24 weeks of gestation and weighed 744g at birth. On admission, the routine blood examination revealed thrombocytopenia and elevated serum IgM level. The diagnosis of congenital CMV infection was made by urinary excretion of CMV, elevated CMV-specific IgM level, and slightly positive CMV antigenemia, although no clinical symptom was observed. At two weeks of postnatal age, he developed hepatosplenomegaly and neutropenia. Afraid of the severe adverse effects of gancyclovir on immature immune system and gonad, repeated CMV Ig administration was initiated at 2weeks of age. After three courses of CMV Ig, his clinical symptoms resolved and CMV antigenemia had disappeared. However, brain ultrasonography and computed tomography on 7 weeks of age revealed a micro calcification on each of cerebral hemisphere. Now he is two years old, and his developmental quotient is borderline value. It seems impossible to judge whether his developmental delay is resulted from his extreme prematurity, CMV microinvasion into his brain.
In present case, total amount of CMV seemed to be relatively small from the level of CMV antigenemia. Although CMV Ig was effective to improve his clinical symptoms, this therapy might insufficient to prevent viral micro-invasion into central nervous system. Further investigation is required to establish the treatment strategy for congenital symptomatic CMV infection in extremely preterm infant as our present case.
