A Diagnostic Dilemma: Was This Death Not a Case of an Infant with Cytomegalovirus Infection?

Abstract

A 3-month-old female infant was referred to a teaching hospital with a 3-day history of fever, fast breathing, cough and 19 hours of yellowish discoloration of sclera. She was deeply jaundiced and febrile, had hepatosplenomegaly, was microcephalic and thrombocytopenic. Child was worked out and treated for bacterial pneumonia, atypical pneumonia, pulmonary tuberculosis, fungal opportunist infection, and heart failure. She was oxygen dependent throughout the 2 months of admission and deteriorated
despite all interventions. Considerations for viral infection was made later into her admission but delayed farther due to financial
challenges. Immunoglobins (IgG and IgM) for Cytomegalovirus (CMV) came up positive. Child had hypoxic pneumonia of which CMV is a documented cause in this age group and could have benefitted from empiric ganciclovir cover if clinicians had thought of it.
There is the urgent need for clinicians to widen the differential list especially when response to conventional treatment is poor. Valid National Health Insurance card holders should benefit from a wider range of laboratory services if our aim to decrease infant mortality will materialize.