Congenital Rubella Syndrome in a Term Male Neonate with Patent Ductus Arteriosus and Bilateral Nuclear Cataracts: A Case Report

Transplacental transmission of rubella virus leads to Congenital Rubella Syndrome. It is comprised of congenital cardiac defects (most commonly patent ductus arteriosus), cataracts and sensorineural hearing loss. While prematurity and intra uterine growth retardation are frequent accompaniments of congenital rubella syndrome, at times birth weight can be normal. The possibility of fetal anomalies due to rubella virus is highest in the first 12 weeks of gestation, which decreases thereafter. PDA is highly prevalent in premature neonates, where as its presence in term neonates signifies either intra uterine infection or genetic disease. A 39weeks, 3200grams, appropriate for gestational age, male neonate was born by vaginal delivery with normal APGARS. The neonate presented with respiratory distress, precardial activity and cardiac murmur on 4th day of life. Hence, congenital heart disease was considered and echocardiography revealed patent ductus arteriosus. While PDA is common in premature neonates, it is a rare manifestation in term newborn babies. The neonate also had bilateral nuclear cataracts in the eyes, implying congenital rubella syndrome and was investigated for the same. Other systemic findings like bilateral cryptorchidism, hepatosplenomegaly and thrombocytopenia were also evident. In addition there was unconjugated hyperbilirubinemia and elevated transaminases. There were no intra cranial calcifications in neurosonogram. Congenital rubella syndrome was confirmed as rubella IgM levels in both mother and neonate were elevated. The neonate received decongestive therapy for patent ductus arteriosus. We report a term, male appropriate for gestational age neonate with PDA and bilateral nuclear cataracts along with elevated rubella IgM levels confirming congenital rubella syndrome.