Journal List > Pediatr Infect Vaccine > v.24(1) > 1095919

Kim, Kang, Lee, Chang, Park, and Kim: Discordant Congenital Cytomegalovirus Infection in Twins

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.

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Fig. 1.
The results of urine cytomegalovirus (CMV) polymerase chain reaction (PCR).
piv-24-65f1.tif
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.
piv-24-65f2.tif
Table 1.
Case Reports of Congenital CMV Infection in Twin Pregnancies
Study Case Chorionicitv Type of maternal infection Conqenital CMV infection Clinical outcome
Seguin etal. (1988)11) 1 MC Unknown Uninfected/infected Asymptomatic/symptomatic
Nigro etal. (1999)13) 1 DC Primary Infected/nfected Asymptomatic/asymptomatic
Azam etal.(2001)14) 1 UL Unknown Infected/unifected Asmptomatic/symptomatic
lazzaroto et al (2003)3) 3 DC Primary Infected/uninfected
Infected/infected/infected
Infected/infected
Symptomatic (fetal death)/asymptomatic
Symptomatic/symptomatic/symptomatic
Asymptomatic/symptomatic
Kawana et al. (2004)7) 1 DC Primary Infected/infected Symptomatic (severe)/symptomatic
Yinon et al.(2006)9 6 DC Primary
 
 
 
 
Recurrent
Uinfected/infected
Infected/infected
Infected/infected
Infected/infected
Infected/infected
Infected/infected
Infected/infected
Asymptomatic/symptomatic (TOP)
Asymptomatic/asymptomatic
Asymptomatic/asymptomatic
Asymptomatic/asymptomatic (death)
Symptomatic (OIFD)/symptomatic (IUFD)
TOP∗/TOP∗
Manoura et al. (2006)15) 1 DC Recurrent Infected/uninfected Symptomatic/asymptomatic
Griesmaier et al. (2010)10) 1 MC Primary Infected/infected Symptomatic/symptomatic
Wu et al. (2011)1) 1 MC Unknown Infected/infected Asymptomatic/symptomatic (fetal death)
Simioni et al. (2013)4) 1 DC Primary Infected/Uninfected Asymptomatic/asymptomatic
Nakajima et al. (2015)12) 1 MC Unknown Infected/infected Symptomatic (severe)/symptomatic
Samedi et al. (2016)8) 1 DC Primary Infected/infected Symotomatic/asymotomatic
Euana–Uarinovic et al. (2016)6) 6 MC
DC
Unknown Infected/infected
Uninfected/infected
Uninfected/infected
Uninfected/infected
Uninfected/infected
Uninfected/infected
Symotomatic/symoptmatic
Asymotomatic/symoptmatic
TOP/asymptomatic
TOP/asymptomatic
TOP (due to NTD)/asymptomatic
IUFD/asymptomatic
Asymptomatic/asymptomatic
Present study 1 DC Unknown Infected/uninfected Symptomatic/asymptomatic

Amniotic fluid results were positive and TOP was performed due to parents' request. Abbreviations: CMV, cvtomeqalovirus; MC, monochorinonic; DC, dichorionic; TOP, termination of preqnancv; IUFD, intrauterine fetal death; NTD, neural tube defect.

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