Title of Case
Acute cytomegalovirus infection in preterm born infant

Background
Cytomegalovirus (CMV) infection is one of the most common viral infections of the newborn. Common mechanisms of the infection include perinatal exposure to infected genitalia secrete during birth or ingestion of breast milk containing CMV. Not always perinatal exposure to CMV are associated with clinical manifestation of disease. However, to premature infants perinatal infection can result in severe, disseminated infection, associated with end-organ damage and death.

Case Presentation Summary
Preterm born infant (28th week of gestation, weight 1.320g) was admitted to neonatal Intensive care unit. Due to respiratory distress, she received respiratory support with CPAP, surfactant application, antibacterial therapy and parenteral nutrition. At the 9th day of life her condition deteriorated-with respiratory insufficiency and lung bleeding secondary to hypocoagulation. Mechanical lung ventilation was started. Since 14th day of life, thrombocytopenia progressed. She received multiple platelets transfusions. Despite of broad spectrum antibacterial therapy, blood component transfusions, repeated surfactant application, the condition continued to deteriorate-with pneimonitis on x-ray examination progressing and increasing the hyperbilirubinemina (at the expense of direct bilirubine). She had unexplained episodes of fever with rising of CRP and Il-6. All the blood cultures were negatives. At the 38th  day of life CMV antigen was confirmed in urine sample, which was considered  to be the cause of pneumonitis, hepatitis and thrombocytopenia. The therapy with ganciclovir was started. Despite of treatment, hepatic failure progressed, ascites appeared. The hypocoagulation with repeated gastrointestinal bleeding repeated. Respiratory insufficiency and hemodynamic problems increased and patient died. 

Learning Points/Discussion
In conclusion, CMV infection must be kept in mind if child have pneumonitis, hepatitis and unexplained thrombocytopenia.

01 / ACUTE CYTOMEGALOVIRUS INFECTION IN PRETERM BORN INFANT