Fujimori Kentaro, Yamada Masaki, Maekawa Takanobu, Yotani Nobuyuki, Tamura Ei-Ichiro, Imadome Ken-Ichi, Kubota Mitsuru, Ishiguro Akira
Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
Department of Advanced Medicine for Virus Infections, National Center for Child Health and Development, Tokyo, Japan.
IDCases. 2019 Nov 23;19:e00675. doi: 10.1016/j.idcr.2019.e00675. eCollection 2020.
Antiviral therapy against cytomegalovirus (CMV) infection is indicated for symptomatic infection in the fetus and premature neonates. In mature neonates, the benefit of antiviral therapy for severe CMV infection remains controversial. Additionally, when diagnosing symptomatic CMV disease occurring during the early neonatal period, it is difficult to differentiate between congenital and acquired infections. We herein report a neonatal case of CMV infection complicated with severe thrombocytopenia that was successfully managed with antiviral treatment. A 21-day-old male infant presented with low-grade fever and erythema on his extremities. During outpatient follow-up, he developed petechiae and thrombocytopenia (platelet count 17,000/μL). Subsequent serological examination and molecular detection of CMV confirmed the diagnosis of CMV infection. In consideration of the severe thrombocytopenia, antiviral therapy with valganciclovir 32 mg/kg/day was initiated. The platelet counts increased with decreasing CMV loads. After excluding congenital CMV infection, we discontinued antiviral therapy without relapse of the disease. The present case suggests that neonatal cases of severe symptomatic CMV infection may require antiviral therapy while excluding the possibility of congenital infection.
针对巨细胞病毒（CMV）感染的抗病毒治疗适用于胎儿和早产新生儿的有症状感染。对于成熟新生儿，抗病毒治疗对严重CMV感染的益处仍存在争议。此外，在诊断新生儿早期发生的有症状CMV疾病时，很难区分先天性感染和后天感染。我们在此报告一例CMV感染合并严重血小板减少症的新生儿病例，该病例通过抗病毒治疗成功治愈。一名21日龄男婴出现低热和四肢红斑。在门诊随访期间，他出现了瘀点和血小板减少（血小板计数17,000/μL）。随后的CMV血清学检查和分子检测确诊为CMV感染。考虑到严重的血小板减少症，开始使用缬更昔洛韦32 mg/kg/天进行抗病毒治疗。随着CMV载量的降低，血小板计数增加。在排除先天性CMV感染后，我们停用了抗病毒治疗，疾病未复发。本病例表明，严重有症状CMV感染的新生儿病例在排除先天性感染可能性的同时可能需要抗病毒治疗。
