Severe neonatal CMV infection complicated with thrombotic microangiopathy successfully treated with ganciclovir

We report a neonate of severe cytomegalovirus (CMV) infection who presented vomiting, severe thrombocytopenia and thrombotic microangiopathy (TMA). He showed occasional vomiting at 3 weeks of age and visited us with systemic petechiae at 29 days old. Platelet was markedly decreased to 18,000/μL and fragmented red blood cells were increased in the peripheral blood. Intravenous ganciclovir (GCV) administration was started at 35 days old after detection of CMV in the peripheral blood. His normal values of T-cell receptor excision circles (TREC) and signal joint kappa-deleting recombination excision circles (sjKREC) excluded the possibility of severe immunodeficiency. Congenital CMV infection was denied later, when CMV of the dried blood spot obtained for neonatal mass-screening at 4 days old was proved negative. We provided 6-week treatment with no side effect such as myelosuppression. The left hearing abnormality found at first was improved along with other symptoms. GCV seems to be effective and safe for severe neonatal CMV infection.