A term neonate presents with petechial rash, jaundice and hepatosplenomegaly. CT brain shows periventricular calcifications and CSF reveals mononuclear pleocytosis. Urine PCR is positive for a double-stranded DNA herpesvirus. The most likely cause and the long-term complication the mother must be counselled about are:

• A Toxoplasma gondii; recurrent seizures from hydrocephalus
• B Rubella virus; cataract and patent ductus arteriosus
• C Cytomegalovirus; progressive sensorineural hearing loss ✓
• D Herpes simplex virus type 2; vesicular skin recurrences

Explanation

Congenital CMV is the most common congenital viral infection. Its classic triad includes petechiae, hepatosplenomegaly and jaundice, with periventricular calcifications and chorioretinitis. Sensorineural hearing loss is the commonest sequela and may progress over the first years of life, so serial audiometry is mandatory even in asymptomatic infants. Toxoplasmosis produces diffuse intracranial calcifications rather than the periventricular pattern, and congenital rubella is defined by cataract and cardiac defects.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.