title: Severe neonatal CMV infection complicated with thrombotic microangiopathy successfully treated with ganciclovir.
abstract: We report a neonate of severe cytomegalovirus (CMV) infection who presented vomiting, severe thrombocytopenia and thrombotic microangiopathy (TMA). He showed occasional vomiting at 3 weeks of age and visited us with systemic petechiae at 29 days old. Platelet was markedly decreased to 18,000/μL and fragmented red blood cells were increased in the peripheral blood. Intravenous ganciclovir (GCV) administration was started at 35 days old after detection of CMV in the peripheral blood. His normal values of T-cell receptor excision circles (TREC) and signal joint kappa-deleting recombination excision circles (sjKREC) excluded the possibility of severe immunodeficiency. Congenital CMV infection was denied later, when CMV of the dried blood spot obtained for neonatal mass-screening at 4 days old was proved negative. We provided 6-week treatment with no side effect such as myelosuppression. The left hearing abnormality found at first was improved along with other symptoms. GCV seems to be effective and safe for severe neonatal CMV infection.
authors.affiliation: Department of Hematology, Oncology and Immunology, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan; Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Mitsuiki
authors.affiliation: Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Tamanuki
authors.affiliation: Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Sei
authors.affiliation: Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ito
authors.affiliation: Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Kishi
authors.affiliation: Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
authors.forename: Yoshiho
authors.initials: Y
authors.lastname: Hatai
authors.affiliation: Department of Hematology, Oncology and Immunology, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan; Department of Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan; Department of Pediatrics, Musashino Red Cross Hospital, 1-26-1, Kyonan-cho, Musashino, Tokyo 180-8610, Japan. Electronic address: mnagasawa.ped@tmd.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nagasawa
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D015774:Ganciclovir / Q000008:administration & dosage*; D034381:Hearing Loss / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011693:Purpura / Q000209:etiology; D057049:Thrombotic Microangiopathies / Q000150:complications / Q000188:drug therapy; D014839:Vomiting / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
keywords: Cytomegalovirus; Ganciclovir; Signal joint kappa-deleting recombination excision circles; T-cell receptor excision circles; Thrombotic microangiopathy