Pediatr Infect Vaccine.  2017 Apr;24(1):65-70. 10.14776/piv.2017.24.1.65.

Discordant Congenital Cytomegalovirus Infection in Twins

• Kim YS
• Kang JM
• Lee JH
• Chang YS
• Park WS
• Kim YJ

• KMID: 2390884
• DOI: http://doi.org/10.14776/piv.2017.24.1.65

Abstract

Cytomegalovirus (CMV) infection is one of the most common congenital infections. The first case of discordant congenital CMV infection in twins occurred in Korea. A 31-year-old woman became pregnant with twins (dichorionic-diamniotic). An elective caesarean section was performed at 37 weeks. The first baby was male, weighing 2,410 g with an Apgar score of 8/9. The second baby was female, weighing 1,380 g with an Apgar score of 5/8. She had experienced intrauterine growth retardation, and presented with microcephaly, micrognathia, and joint stiffness. During the work-up for discordant twins, the second baby's serum test was positive for CMV immunoglobulin M. Her urine, blood, and cerebrospinal fluid (CSF) were CMV polymerase chain reaction positive. The first baby's CMV tests were negative. Ophthalmologic exam and audiometry performed on the second baby showed CMV retinitis and bilateral sensorineural hearing loss. She was treated with intravenous ganciclovir. Currently, she is bed-ridden and has significant developmental delay. Although the causes of discordant congenital CMV infection in twins are unclear, this case shows that discordant congenital CMV infection should be considered in twins with significant differences in intrauterine growth or clinical symptoms after birth.

Keyword

Congenital; Infection; Cytomegalovirus; Twins

MeSH Terms

Adult
Apgar Score
Audiometry
Cerebrospinal Fluid
Cesarean Section
Cytomegalovirus Infections*
Cytomegalovirus*
Female
Fetal Growth Retardation
Ganciclovir
Hearing Loss, Sensorineural
Humans
Immunoglobulin M
Joints
Korea
Male
Microcephaly
Micrognathism
Parturition
Polymerase Chain Reaction
Pregnancy
Retinitis
Twins*
Ganciclovir
Immunoglobulin M

Figure

• 

  Fig. 1. The results of urine cytomegalovirus (CMV) polymerase chain reaction (PCR).

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  Fig. 2. (A, B) Brain ultrasonography performed 2 days after birth shows ventriculomegaly with increased periventricular echogenicity. (C, D) Brain magnetic resonance imaging at postnatal age 4 months shows cortical malformation and extensive white matter volume loss with circumventricular calcifications (arrow) and cerebellar hypoplasia.

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