Grand Rounds

A 3 months old with pneumonia and positive cytomegalovirus IgM

Suhani Jain1, Ira Shah2
1Grant Government Medical College, Sir JJ Group of Hospitals, Mumbai, India, 2Consultant in Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India

Address for Correspondence: Suhani Jain, Flat number 402, Ramdeo Arise, Behind Hotel Airport Centre Pt, Wardha Road, Nagpur-440025. Email:

Keywords: Congenital CMV, Acquired CMV, CMV IgM

Clinical Problem:
Problem - A 3 ½ month-old female infant on exclusive breast feeds presented with constipation for 4 days. She had pneumonia 15 days ago which was treated with IV Ceftriaxone and IV amikacin for 7 days at another hospital. The attending physician in that hospital did a TORCH titres in the child and Rubella IgG was positive (11.7 AU/ml), Cytomegalovirus (CMV) IgG was positive (77.3 AU/ml) and CMV IgM was also positive (0.98 AU/ml). Mother’s TORCH titres were done in the first trimester of the pregnancy in view of bad obstetric history and Mother’s Rubella IgG (393.42 AU/ml) was positive at that time. Other TORCH IgG and TORCH IgM in the mother were negative at that time. The infant was born of a non-consanguineous marriage at 9 months of gestation by normal vaginal delivery and had a birthweight of 2.5 kg. There were 2 fetal deaths in the mother prior to this pregnancy and the first fetal death occurred at 9 months of gestation and the second occurred at 3 months of gestation, the causes of which were unknown. At presentation, the weight of the infant was 5.7kg (25th-50th centile as per World Health Organisation (WHO) charts), total body length was 60 cms (50th-75th centile as per WHO growth charts) and head circumference was 39cms (25th-50th centile as per WHO growth charts), general examination was normal and there was hepatosplenomegaly. Other systems were normal. On investigation, hemoglobin was 11.5gmdl, white cell count was 7800 cells/cumm (56% polymorphs, 40% lymphocytes) and platelet count was 4,15,000 cells/cumm. Serum aspartate transaminase (AST) was 35 IU/L and alanine transaminase (ALT) was 28 IU/L. CMV viral load in plasma was undetectable. CMV IgG avidity in the child was low (40.8%) and CMV IgG was 303 Au/ml. Hearing evaluation and ophthalmological examination of the child were normal. CMV titres done currently in the mother showed that CMV avidity was high (90.9%) and CMV IgG was 1087.7 Au/ml. CMV IgM in the mother was negative. The child is on regular follow up.

Is this congenital CMV or acquired CMV?

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