Neonatal Med.  2021 May;28(2):83-88. 10.5385/nm.2021.28.2.83.

Disseminated Postnatal Cytomegalovirus Infection in a Preterm Neonate: Autopsy Case Report

• Kim KY
• Kim EK
• Park SH
• Kim YJ
• Shin SH
• Kim HS

• KMID: 2516490
• DOI: http://doi.org/10.5385/nm.2021.28.2.83

Abstract

Treatment guidelines for postnatal cytomegalovirus (pCMV) infection in preterm have not been established yet. Neutropenia, thrombocytopenia, hepatitis, colitis, and sepsis-like disease are among the clinical manifestations, which range from moderate to serious. We present a case of autopsy diagnosed as pCMV infection in a premature infant delivered at gestational age of 24 weeks and 5 days. On the 7th and 14th days of birth, urinary CMV polymerase chain reaction samples were negative, ruling out congenital CMV infection. However, autopsy examination revealed that the patient had disseminated pCMV infection. CMV inclusion bodies were found in the majority of tissues, including the lung, liver, pancreas, breast, kidney, and adrenal gland, but not the placenta. The thymus exhibited significant cortical atrophy and T-cell immunodeficiency, possibly induced by dexamethasone treatment for bronchopulmonary dysplasia or by pCMV infection itself. If dexamethasone treatment is extended or high doses are considered, it may be beneficial to test the CMV infection status to prevent aggravation of infection. This case demonstrates that, despite the low prevalence, pCMV infection should be considered a differential diagnosis in preterm if other conditions or etiology cannot justify clinical deterioration.

Keyword

Cytomegalovirus infections; Infant, extremely low birth weight; Sepsis; Autopsy; Immunologic deficiency syndromes

Figure

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  Figure 1. Chest radiographs of the twins. A chest radiograph of one of the twins (A) and the other twin (B) on the 9th day of life demonstrated reticular opacities on both lungs.

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  Figure 2. (A) A cytomegalic alveolar lining cell with basophilic inclusions. (B) Cytomegalovirus (CMV) immunohistochemistry reveals CMV inclusions (A: H&E, B: CMV immunohistochemistry; cale bar = 50 μm).

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  Figure 3. (A) Thymus shows cortical atrophy. (B) CD99 immunohistochemistry shows no cortical T-cell in the entire thymus. (C, D) CD3 and CD8-positive T-cells are scattered mainly in the medulla (A: H&E, B: CD99, C: CD3, D: CD8 immunohistochemistry; scale bar = 200 μm).

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  Figure 4. Changes in patient’s respiratory severity score (RSS; calculated by multiplying the mean airway pressure by the fraction of inspired oxygen) of the patient. RSS significantly increased at 39 days after birth. Abbreviation: ALT, alanine aminotransferase.

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