Acute Febrile Illness as a Manifestation of Cytomegalovirus Infection in Extremely Low-Birth Weight Babies—A Case Series

Abstract

Cytomegalovirus (CMV) infection in extremely low-birth weight infants (ELBW) is associated with significant morbidity and mortality. Our case series elaborates the profile and outcomes of 5 ELBW neonates with likely postnatal CMV infection. All babies were on mothers’ own milk and had a history of receiving leuko-reduced packed red blood cells. The mean age at diagnosis was 64 days. Hepatosplenomegaly was present in 4 cases. Along with other features warranting testing for CMV, unusually all the 5 neonates had fever spikes at the time of deterioration. Three cases had thrombocytopenia. Atypical clinical feature in the form of papular lesions, which healed with hyperpigmentation, was noted in a neonate. The fever subsided after starting treatment with valganciclovir. All babies developed bronchopulmonary dysplasia requiring prolonged respiratory support. Two babies expired. Duration of treatment with valganciclovir ranged from 6 weeks to 6 months. Survivors were developmentally normal on follow-up with normal hearing and ophthalmic examination. Febrile spikes with worsening of pre-existing morbidities could be an important clue to acquired CMV infection.