Background Usually retinitis is associated with congenital CMV and does not progress postnatally in the immunocompetent neonate, whereas in immunodeficient patients it can progress rapidly.
Objective To describe the case of a neonate with perinatal CMV infection and active retinitis. A neonate born at 38 weeks gestational age, birth weight 2850 g, hospitalized at 34 days of life for CMV infection. Pregnancy was uneventful, maternal serology demonstrated IgG antibodies but not IgM antibodies against CMV. Active CMV infection was confirmed in the neonate by virus isolation from urine and CMV PCR in saliva, whole blood and plasma. Cerebral and abdominal scans were normal. Eye examination on admission revealed retinal hemorrhages and retinal detachment in the left eye. After 3 days retinal detachment in the left eye was complete and the right eye presented several retinal hemorrhages. An ocular scan of the left eye confirmed retinal detachment. The study of the immune system of the neonate was normal, serology for AIDS was negative.
Treatment with i.v. ganciclovir 10 mg/kg/day was started in view of the active retinitis. Two weeks after treatment the hemorrhage and exudation in both eyes were resolving. After three weeks complete resolution of the infection occurred in the right eye and i.v. therapy was stopped. Oral valganciclovir 30 mg/kg/day was then started and continued for further 3 weeks.
Conclusions While very unusual, CMV retinitis has to be taken into consideration in neonates with early postnatally acquired CMV infection. An early diagnosis and treatment may be crucial to avoid visual impairment.
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