Background Congenital cytomegalovirus (cCMV) is a major cause of sensorineural hearing loss and significant neurodevelopmental morbidity. Treatment of symptomatic patients with valganciclovir (VGCV) for 6 months is recommended to improve outcomes. Limited data are available on optimal dosing and toxicity in preterm and extremely low birth weight infants, and none are apparent on the effect of steroids on the course of cCMV. Case Summary We describe a male infant born at 27 weeks 2 days gestational age, with cCMV disease treated with ganciclovir (GCV) and VGCV. After initial response to treatment, he developed worsening clinical status and increased viral load. Treatment was changed to foscarnet due to possible viral drug resistance. Mutation A594V in the CMV UL97 gene conferring GCV resistance was identified. Hospital course was notable for two courses of steroids, severe neutropenia, anemia, and thrombocytopenia, acute kidney injury, cholestasis, and pneumonitis. The patient died on day of life 123. Conclusion More studies are needed to assess optimal GCV/VGCV dosing in preterm and very low birth weight infants with cCMV, the effect of steroid therapy on clinical course, and risk factors for emergence of drug resistance.
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Martin et al. (2026) studied this question.