A 2-day-old neonate is found to have thrombocytopenia (platelet count 35,000/µL), jaundice, and hepatomegaly. The mother had a flu-like illness at 10 weeks gestation. Which of the following congenital infections is MOST likely and which clinical feature is MOST characteristic of this specific infection?
- A Congenital CMV — sensorineural hearing loss and periventricular calcifications
- B Congenital HSV — skin-eye-mouth lesions appearing at day 5–14
- C Congenital rubella — 'salt and pepper' retinopathy and patent ductus arteriosus ✓
- D Congenital toxoplasmosis — chorioretinitis, hydrocephalus, and intracranial calcifications
Explanation
A flu-like illness at 10 weeks gestation (first trimester), combined with thrombocytopenia, jaundice, hepatomegaly in the neonate strongly suggests congenital rubella. First-trimester maternal rubella carries the highest teratogenic risk (>85% if before 12 weeks). The classic triad of congenital rubella syndrome is cataracts/glaucoma, cardiac defects (PDA, pulmonary artery stenosis), and sensorineural deafness. 'Salt and pepper' retinopathy (pigmentary changes) is the characteristic ocular finding of congenital rubella. Thrombocytopenic purpura ('blueberry muffin baby') is also classic.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.