Congenital Rubella with Autism and Evidence of a Remote Stroke

Background: The conventional diagnosis of congenital rubella is a rare occurrence of an obvious maternal exposure, resulting in an infant born with obvious signs such as cataracts, deafness, microcephaly or congenital heart disease. Patient: In this case, a mother with no known symptom, sign or exposure of rubella gave birth to a male infant without complication. The infant had no notable abnormalities at birth. The boy had developmentally delay, and between the ages of five and seven years was diagnosed with autism. At the age of ten years, an MRI of his brain evidenced a remote stroke. Careful examination of all medical records showed that the mother had a considerable rise in her rubella titer and thus had been exposed to rubella during pregnancy. Result: The diagnosis of congenital rubella was recognized more than ten years after the birth of the infant; congenital rubella is linked to both autism and ischemic brain injury. Conclusions: This case illustrates how both maternal rubella exposure and congenital rubella are likely underrecognized, and how a newborn may exhibit no outward symptoms at birth, yet the elusive diagnosis of congenital rubella is considered years later.