A CASE REPORT OF CYTOMEGALOVIRUS ENCEPHALITIS IN INFANT
Jerrell Francie,Susilawati Susilawati
Faculty of medicine Atma Jaya University Department of Child Health, Atma Jaya Hospital, Jakarta
Background : Cytomegalovirus (CMV) infection is the leading cause of neurodevelopmental disability in developed countries. Most maternal infections are asymptomatic and sequel onset from CMV infection are frequently delayed made the challenging diagnosis. Seizure shows that the encephalitis is already occurred. We present a case report of an infant with prolonged neglected seizure diagnosed with CMV encephalitis.
Case Presentation Summary : A 3-months old infant presented to emergency department with tonic seizure for 7 times in a day with flu like symptoms since 1 weeks before admission. The patient had a history of preterm labor, 1300 grams in weight and hospitalized for 1 months and 21 days in Neonatal Intensive Care Unit in different hospital. When came to our hospital, she appeared severely ill with tachycardia, loss of consciousness and seizures. On neurologic examination, we noticed no signs of pathologic reflexes. Her laboratory showed normal leukocyte count with lymphocyte dominant in differential count (37%). She also had moderate hyponatremia and hypoglycaemia. Her non-contrast brain CT scan showed ischemia and edema in bilateral temporoparietal region. Her cerebrospinal fluid Polymerase Chain Reaction (PCR) was positive for CMV 3 days after admission. She was diagnosed with CMV infection. She was hospitalized for 3 days in Pediatric Intensive Care Unit and 5 days in general ward. After discharge, the symptoms resolved spontaneously.
Learning Points/Discussion : We present a case report of an infant presented with prolonged seizure and flu like symptoms but actually had active CMV encephalitis diagnosed by the PCR. Failure to thrive and neurodevelopmental delay alert us to aware about the poor outcome of this infection. Immediate treatment with antivirus revealed favorable outcome.