A Clinically Diagnosed Congenital Rubella Syndrome and Congenital Cytomegalovirus Co-infection

This is a case of four-month-old female infant who presented with clinical manifestations congenital rubella syndrome (CRS) — bilateral cataracts, poorly-dilating pupils, microcorneas, salt and pepper retinopathies seen after cataract extractions, sensorineural hearing loss, patent ductus arteriosus, microcephaly, history blueberry spots low birth weight, positive serum IgM IgG tests for rubella. The patient’s mother also had prenatal infection. However, the patient additional set findings not in recent patients CRS commonly reported literature: visual acuities poor to no dazzle, choroidal thickening on ocular ultrasound that spontaneously resolved, optic nerve inflammation became atrophic, vessel tortuosities subependymal cysts lenticulostriate vasculopathy basal ganglia, ganglia hyperintensity suggestive calcification, jaundice. These plus overlapping cytomegalovirus (CMV) made us consider CMV co-infection. CRS already causes significant childhood morbidity. Getting co-infected utero worsens morbidity makes management more difficult. co-infection discussed added challenges their diagnosis management.