Congenital Rubella Syndrome with Basal ganglia calcification and Bilateral Nuclear Cataracts in a Neonate: A Rare Entity

In-utero transmission of rubella virus during pregnancy leads to congenital Rubella syndrome (CRS), which is characterized by cataracts, deafness and sensorineural hearing loss. While the nuclear cataract is the most frequently occurring abnormality, basal ganglia calcification is a rarer manifestation. The Risk of fetal transmission of rubella virus is highest during the first 12 weeks of gestation and decreases afterwards. A 36weeks, 2600grams male neonate was born by vaginal delivery with normal APGARS. The neonate was admitted on third day of life with complaints of yellowish discoloration of the skin and sclera. On examination, the neonate had mild hypotonia, icterus up to the legs and systolic murmur on cardiac examination. Interestingly, the ophthalmological examination revealed bilateral nuclear cataracts. Chest radiograph showed cardiomegaly and ECHO revealed PDA (Patent Ductus Arteriosus). Hence, CRS was suspected and further evaluation was done. There was thrombocytopenia, mild unconjugated hyperbilirubinemia with mild elevation of transaminases. Another rare finding was basal ganglia calcification on neurosonogram. TORCH profile in both mother and baby showed elevated rubella IgM levels confirming CRS. The neonate received supportive and symptomatic treatment. We report a preterm, male appropriate for gestational age neonate with congenital rubella syndrome and its rare manifestation of basal ganglia calcification.