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Congenital cytomegalovirus infection in twin pregnancy
  1. Ana Araújo Carvalho1,
  2. Cláudia B Silva1,
  3. Maria Luísa Martins2 and
  4. Gonçalo Cassiano Santos3
  1. 1Pediatrics Department, Hospital Dona Estefânia, Lisboa, Portugal
  2. 2Obstetrics Department, Prenatal Diagnosis Center, Maternidade Doutor Alfredo da Costa, Lisboa, Portugal
  3. 3Neonatal Intensive Care Unit, Maternidade Doutor Alfredo da Costa, Lisboa, Portugal
  1. Correspondence to Dr Ana Araújo Carvalho; anacarvalho.fcm{at}


Cytomegalovirus (CMV) infection is one of the preeminent congenital viral infections, and despite its potential morbidity, uncertainty about its physiopathology, prevention and treatment remains until now. We report a case of a dichorionic and diamniotic twin pregnancy in which only one of the fetus had signs of being affected. The first twin had prenatal diagnosis of intrauterine growth restriction and hyperechogenic bowel, attributable to CMV infection, while there was no evidence of infection of the second one. Prenatal treatment was done with maternal administration of valacyclovir and postnatal treatment of the infected newborn with oral valganciclovir with normal neurodevelopment assessment at 12 months corrected age. In this case, maternal CMV infection was not equally transmitted to both fetuses, suggesting that there may be intrinsic fetal and placental factors influencing both transmission and the clinical features of the infection.

  • congenital disorders
  • materno-fetal medicine
  • infectious diseases

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  • Contributors AAC and CBS, as pediatric residents, were responsible for patient management during hospital stay. They started the bibliographic review of CMV congenital infection, outlined the first draft of the article and concluded the subsequent reviews of other authors. MLM was responsible for the diagnosis of CMV congenital infection of one fetus, for the decision of prenatal treatment with valacyclovir, and for the writing revision of obstetric issues in the article. GCS supervised clinical management and was responsible for full writing revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.