Cytomegalovirus infection and hepatitis
Dr Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai
Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056, India.
Clinical Problem :
A 4 month old boy, 2nd born of third degree consanguineous marriage presented with not gaining weight since birth. He was a full term normal delivery with birth weight of 3 kg. Mother had fever at 7-8 months of gestation and had received antibiotics orally for same. The child on Day 15 of life developed rash over body with fever which cleared off in 4 days. He was given IV antibiotics for 4 days. He had recurrent cough since 1½ months of age with regurgitation of food since 15 days for which he was advised propped up position. His milestones and immunization were normal. He was on breast feeds and started on formula feeds, a month back in view of poor weight gain. At 2 months of age, had hematemesis with malena and was given whole blood transfusion and fresh frozen plasma. An older male child had died at 1½ months of age due to failure to thrive. On examination, he was malnourished {weight = 2.75 kg, length = 56 cm}, had pallor, large eats and firm hepatomegaly. Other systems were normal. Investigations showed:
• Hemoglobin = 10.8 gm, dl
• WBC count = 27,300, cumm {78 percent polymorphs, 20 percent lymphocytes}
• Platelet count = 8,07,000, cumm
• Venous blood gas = pH = 7.362, bicarbonate = 21 mmol, L
• Urine = Normal
• CRP = Negative
• Bilirubin = 2.5 mg percent {direct = 1.3 mg percent}
• SGOT = 123 IU, L, SGPT = 66 IU, L {elevated}
• Total proteins = 6.7 gm percent, Albumin = 2.3 gm percent
• S. creatinine, electrolytes, calcium, alkaline phosphatase = Normal
• VDRL, HIV ELISA = Negative
• Ultrasound abdomen = Normal
• Urine for reducing substance = Negative
• TORCH = Cytomegalovirus {CMV} IgG positive, Rest all IgM and IgG negative
• Blood culture = No growth
• CMV viral load = 3000 copies, ml
• Hearing and eye examination = Normal
• GER = Normal study
After 10 days, liver enzymes and bilirubin were normal and CBC was also normal and child’s regurgitation episodes also decreased.
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