A Newborn Baby With An Extensive Skin Rash

A newborn boy is brought to the pediatrician for further evaluation of an extensive skin rash.
Physical examination shows that this child has microcephaly, hearing loss, and a petechial skin rash. The abdominal examination reveals hepatosplenomegaly.
Further questioning of the infant’s mother reveals that she had “the
fl u” early in her pregnancy. A tissue sample from the infant is sent for culture, which confirms the diagnosis. Which of the following is the correct diagnosis?

(A) Congenitally acquired cytomegalovirus
(B) Congenitally acquired Epstein-Barr virus
(C) Congenitally acquired herpes simplex virus
(D) Congenitally acquired HIV
(E) Congenitally acquired syphilis

Answer And Discussion:


The correct answer is A. This is a case of congenitally acquired cytomegalovirus (CMV) infection.
Fetuses exposed to CMV during the first trimester may experience intrauterine growth retardation and be afflicted with central nervous system damage, with hearing and sight impairments. Mental retardation will occur along with microcephaly. A characteristic “blueberry muffin rash” is usually present.

Answer B is incorrect. Epstein-Barr virus, the cause of infectious mononucleosis, is a rare cause of congenital defects. These defects include cataracts, hypotonia, cryptorchidism, and micrognathia.

Answer C is incorrect. Herpes simplex virus can result in a variety of congenital defects, abortions, and neonatal encephalitis.

Answer D is incorrect. Congenital HIV results in neonatal AIDS.

Answer E is incorrect. Congenital syphilis can result in cranial nerve VIII deafness, mulberry
molars, saber shins, saddle nose, and Hutchinson’s teeth.