Infantile spasms in an infant with cytomegalovirus infection treated with ganciclovir

Area of Science:

• Neonatal neurology
• Pediatric infectious diseases
• Virology

Background:

• Cytomegalovirus (CMV) infection is a common cause of congenital neurological impairment.
• Intractable seizures and developmental delay are significant challenges in affected infants.
• Ganciclovir is an antiviral medication used to treat CMV infections.

Observation:

• A 3-month-old infant with CMV infection and intractable partial seizures received 6 weeks of ganciclovir.
• The treatment successfully eliminated CMV shedding in cerebrospinal fluid and urine.
• However, the infant later developed infantile spasms and persistent seizures, with marked psychomotor delay.

Findings:

• Ganciclovir effectively halts CMV shedding in infants.
• The treatment did not prevent the subsequent development of infantile spasms.
• Persistent seizures and psychomotor delay were observed despite viral clearance.

Implications:

• Ganciclovir may not reverse or prevent neurological sequelae of congenital CMV infection.
• Irreversible brain damage from CMV may occur prior to or despite antiviral therapy.
• The virostatic nature of ganciclovir might limit its efficacy in preventing long-term neurological outcomes.