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Case Reports: Unusual association of diseases/symptoms
Congenital CMV associated with diaphragm dysfunction: a rare cause of tachypnoea
  1. Rebecca Carter1,2,
  2. Maayan Yakir1,
  3. Julie Ryu3 and
  4. Katherine Weiss1,4
  1. 1Pediatrics, UC San Diego, La Jolla, California, USA
  2. 2Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
  3. 3Pediatrics, Division of Pediatric Pulmonary Medicine, Rady Children's Hospital San Diego, San Diego, California, USA
  4. 4Pediatrics, Division of Neonatology, Rady Children's Hospital San Diego, San Diego, California, USA
  1. Correspondence to Dr Rebecca Carter; rebecca.carter{at}ucsf.edu

Abstract

A late preterm infant with intrauterine growth restriction developed respiratory distress, tachypnoea and hypoxia after birth, requiring supplemental oxygen. Chest radiographs demonstrated persistent elevation of the right hemidiaphragm. Chest ultrasound initially demonstrated symmetrical bilateral diaphragm motion, but subsequent ultrasounds showed asymmetrical excursion with weaker movement of the right hemidiaphragm. Placental pathology demonstrated chronic infectious villitis secondary to cytomegalovirus (CMV), and subsequent CMV testing on the infant was positive. The infant was microcephalic and head imaging revealed intracranial calcifications, consistent with congenital CMV infection.

CMV is the most common congenital infection and has a wide array of clinical manifestations. This report highlights the rarely described association between congenital CMV infection and respiratory distress due to underlying diaphragm dysfunction. In neonates with respiratory distress and features of congenital CMV infection, clinicians should have a high index of suspicion for diaphragm dysfunction.

  • Neonatal intensive care
  • Congenital disorders
  • Neonatal and paediatric intensive care
  • Neonatal health
  • Respiratory medicine

https://doi.org/10.1136/bcr-2021-247959

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—RC, MY, JR and KW. The following authors gave final approval of the manuscript—RC, MY, JR and KW.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.