A small-for-gestational-age neonate born to a first-time mother is found on day 1 to have bilateral sensorineural hearing loss, periventricular calcifications on cranial USG, hepatosplenomegaly, petechiae/purpura, and conjugated hyperbilirubinemia. The MOST likely congenital infection and the confirmatory test are:

• A Congenital rubella; anti-rubella IgM in neonate
• B Congenital toxoplasmosis; serum IgM by ELISA
• C Congenital CMV; urine CMV PCR within 3 weeks of birth ✓
• D Congenital herpes; surface swabs + CSF HSV PCR

Explanation

Periventricular (subependymal) calcifications are pathognomonic of congenital CMV, distinguishing it from toxoplasmosis which causes diffuse cortical calcifications. The full picture — SNHL, periventricular calcifications, hepatosplenomegaly, purpura (blueberry muffin-like), and conjugated jaundice in an SGA neonate — is classic congenital CMV. Confirmatory diagnosis requires urine or saliva CMV PCR (or viral culture) obtained within 3 weeks of birth; samples collected after 3 weeks cannot distinguish congenital from postnatal acquisition. Rubella presents with cataracts + cardiac defects + SNHL without periventricular calcifications. HSV presents with vesicular skin lesions, encephalitis, and disseminated disease.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.