Correspondence

Case 25-2003: Congenital Cytomegalovirus Infection

N Engl J Med 2003; 349:1575-1576October 16, 2003

Article

To the Editor:

Participants in the discussion of the differential diagnosis in Case 25-2003 (Aug. 14 issue),1 involving a neonate with intrauterine growth retardation, hepatosplenomegaly, thrombocytopenia, and periventricular calcifications, fail to mention lymphocytic choriomeningitis virus infection.2 Congenital lymphocytic choriomeningitis virus infection has been diagnosed in more than 50 infants.3,4 Periventricular calcifications and chorioretinitis occur in approximately 90 percent of such neonates. Microcephaly or macrocephaly (commonly) and hepatosplenomegaly and petechiae (rarely) have also been noted. Lymphocytic choriomeningitis virus is an arenavirus asymptomatically shed by chronically viremic mice and variably symptomatic golden hamsters. It is thus a potentially preventable zoonotic infection and should be included in the differential diagnosis of illnesses in neonates such as the patient described in the Case Records.

Leslie L. Barton, M.D.
University of Arizona School of Medicine, Tucson, AZ 85724
llb@peds.arizona.edu

4 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 25-2003). N Engl J Med 2003;349:691-700
   Full Text | Web of Science | Medline

2. 2

   Wright R, Johnson D, Neumann M, et al. Congenital lymphocytic choriomeningitis virus syndrome: a disease that mimics congenital toxoplasmosis or cytomegalovirus infection. Pediatrics 1997;100:126-127 abstract.
   CrossRef | Web of Science

3. 3

   Barton LL, Mets MB. Congenital lymphocytic choriomeningitis virus infection: decade of rediscovery. Clin Infect Dis 2001;33:370-374[Erratum, Clin Infect Dis 2001;33:1445.]
   CrossRef | Web of Science | Medline

4. 4

   Barton LL, Mets MB, Beauchamp CL. Lymphocytic choriomeningitis virus: emerging fetal teratogen. Am J Obstet Gynecol 2002;187:1715-1716
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Barton and colleagues have written several articles that remind us of the importance of lymphocytic choriomeningitis virus as a vertically transmitted viral pathogen.1-4 However, this virus is very rarely a cause of hepatomegaly, hyperbilirubinemia, or thrombocytopenia,2 all of which were prominent presenting manifestations in the case under discussion.

John F. Modlin, M.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756
john.modlin@dartmouth.edu

4 References

1. 1

   Mets MB, Barton LL, Khan AS, Ksiazek TG. Lymphocytic choriomeningitis virus: an underdiagnosed cause of congenital chorioretinitis. Am J Ophthalmol 2000;130:209-215
   CrossRef | Web of Science | Medline

2. 2

   Barton LL, Mets MB. Congenital lymphocytic choriomeningitis virus infection: decade of rediscovery. Clin Infect Dis 2001;33:370-374[Erratum, Clin Infect Dis 2001;33:1445.]
   CrossRef | Web of Science | Medline

3. 3

   Barton LL, Peters CJ, Ksiazek TG. Lymphocytic choriomeningitis virus: an unrecognized teratogenic pathogen. Emerg Infect Dis 1995;1:152-153
   CrossRef | Web of Science | Medline

4. 4

   Barton LL, Mets MB, Beauchamp CL. Lymphocytic choriomeningitis virus: emerging fetal teratogen. Am J Obstet Gynecol 2002;187:1715-1716
   CrossRef | Web of Science | Medline