title: CMV infection associated with severe lung involvement and persistent pulmonary hypertension of the newborn (PPHN) in two preterm twin neonates.
abstract: The diagnosis of congenital CMV is usually guided by a number of specific symptoms and findings. Unusual presentations may occur and diagnosis is challenging due to uncommon or rare features. Here we report the case of two preterm, extremely low birthweight, 28-week gestational age old twin neonates with CMV infection associated with severe lung involvement and persistent pulmonary hypertension of the newborn (PPHN). They were born to a HIV-positive mother, hence they underwent treatment with zidovudine since birth. Both infants featured severe refractory hypoxemia, requiring high-frequency ventilation, inhaled nitric oxide and inotropic support, with full recovery after 2 months. Treatment with ganciclovir was not feasible due the concomitant treatment with zidovudine and the risk of severe, fatal toxicity. Therefore administration of intravenous hyperimmune anti-CMV immunoglobulin therapy was initiated. Severe lung involvement at birth and subsequent pulmonary hypertension are rarely described in preterm infants as early manifestations of CMV congenital disease. In the two twin siblings here described, the extreme prematurity and the treatment with zidovudine likely worsened immunosuppression and ultimately required a complex management of the CMV-associated lung involvement.
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy. Electronic address: paolomanzoni@hotmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Manzoni
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Vivalda
authors.affiliation: Department of Pediatrics, University of Torino, Italy.
authors.forename: Michael
authors.initials: M
authors.lastname: Mostert
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Priolo
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Galletto
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Gallo
authors.affiliation: Patologia Neonatale IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Stronati
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Gili
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Opramolla
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Calabrese
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Tavella
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Luparia
authors.affiliation: Neonatology and NICU, S. Anna Hospital, Torino, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Farina
mesh_terms: D000328:Adult; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis*; D007231:Infant, Newborn; D007234:Infant, Premature; D014427:Twins
keywords: CMV; Infection; Neonate; Preterm; Pulmonary hypertension