This is a 45-day-old child who was taken to the emergency department for presenting generalized petechiae and bloody stools.
It was the product of the first pregnancy of the mother, who came to the controls but did not provide certification of laboratory tests performed during pregnancy, although she affirmed that the results of the serological tests did not show febrile adenopathy or syphilis vaccine.
The final delivery route was cesarean section due to fetal-pelvic morbidity.
The newborn had adequate weight and height and normal neonatal adaptation, showed no stigma of apparent clinical infection, received breastfeeding and formula milk, and had the immunization schedule required for his age.
The boy attended a neighborhood with a deficit in infrastructure for public services and basic environmental sanitation, in Carta gena de Indias, Colombia.
The child was taken to the emergency room with petechiae on skin, gums and nose for three days. Two soft bloody stools were added on the last day.
On physical examination, the patient was hemodynamically stable 5.5, with no respiratory mucocutaneous reflex height generali, normocephalia active Normocardic Mass, anterior normotensive, normal otorhinolaryngology examination, heart sounds cardiac tachycardia 36.5 cm.
The hemogram reported moderate anemia on admission and subsequently severe (according to the World Health Organization classification), normocytic and normochromic nonregenerative, moderate and acquired thrombocytopenic thrombocytopenic.
Coagulation times were within normal limits, transaminase levels were slightly altered, and there was a significant increase in lactic dehydrogenase (LDH) levels.
1.
There was a diagnostic impression of bleeding disorder of etiology for determining and suspecting perinatal infection, so serological tests for ToxoCH (Toxoplasmosis, Other (herpes simplex virus), Rub were performed.
1.
The determination of IgG and IgM antibodies was positive for cytomegalovirus.
There were no changes in serum electrolytes or renal function tests.
Anemia required transfusion of 55 ml packed red blood cells.
In the simple and contrasted computerized tomography (CT) of the skull, small blood vessels were observed, a finding that was confirmed by magnetic resonance imaging (MRI), in which subacute bleeding was also observed in the same place.
1.
The diagnosis was confirmed by PCR for cytomegalovirus and, due to the low platelet levels and the risk of bleeding, treatment was initiated with the general medical condition evidenced by a favorable evolution of platelets at a dose of 5 mg/kg for 15 days.
Enteritis was managed and resolved satisfactorily.
Laboratory tests were performed until day 22 of hospital stay.
Treatment with intravenous ganvir was irregularly administered due to supply difficulties, which prolonged hospital stay to 40 days.
The patient received comprehensive management by the professionals of the departments of infectology, radiology and neurosurgery, without presenting more lesions in the organs under observation, and was discharged to continue the follow-up in external consultation.
