-Case Reports-

A Neonate with Reduced Cytomegalovirus DNA Copy Number and Marked Improvement of Hearing in the Treatment of Congenital Cytomegalovirus Infection

Jun Hayakawa^1,2, Yasuhiko Kawakami¹, Sachiyo Takeda¹, Hiroshi Ozawa^1,3, Ryuji Fukazawa¹, Masato Takase¹ and Yoshitaka Fukunaga²

¹Department of Pediatrics, Nippon Medical School Tama Nagayama Hospital
²Department of Pediatrics, Nippon Medical School
³Department of Handicapped Children's Support, Shimada Center for Rehabilitation and Neurodevelopmental Intervention

Congenital cytomegalovirus (CMV) infection can cause severe permanent disabilities. A mother who is seronegative before conception but acquires infection during pregnancy is a risk factor for congenital infection. We describe a neonate in whom congenital CMV infection was diagnosed at birth and confirmed with DNA quantitation by means of the polymerase chain reaction, was accompanied by cerebral ventriculomegaly and severe hearing loss, and was treated with ganciclovir/valganciclovir for 6 weeks. Initially, cerebral ventriculomegaly and calcification were also found with computed tomography, and severe hearing loss was detected with auditory brainstem response testing. After treatment, CMV DNA decreased in copy number and became undetectable. No marked side effects occurred after treatment. Surprisingly, 1 year after treatment, neurological and motor development was equivalent to that in a healthy infant. Audiometry indicated that auditory ability would improve with rehabilitation, speech and language therapy, and cochlear implantation. Single-photon emission computed tomography showed marked improvement 6 months after treatment. This case provides compelling evidence that a reliable diagnosis of congenital CMV infections coupled with a prompt and appropriate treatment program can prevent permanent disability. It is, therefore, important to establish a more effective strategy for the management of congenital CMV infection.

J Nippon Med Sch 2012; 79: 471-477

Keywords
congenital cytomegalovirus infection, ganciclovir, valganciclovir, hearing loss, auditory brainstem response

Correspondence to
Jun Hayakawa, Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
shuros0905@gmail.com

Received, January 30, 2012
Accepted, February 24, 2012