Congenital Cytomegalovirus Presenting with Macrocephaly and Intracranial Abscess: A Case Report
Authors
Dr. Mykha Marie B. Tabuzo-Acuin
Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, College of Medicine and Philippine General Hospital, University of the Philippines Manila
https://orcid.org/0000-0002-3282-5846
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Dr. Miguel Enrico S. Acuin
College of Medicine and Philippine General Hospital, University of the Philippines Manila
, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
Dr. Benilda Sanchez-Gan
Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
https://orcid.org/0000-0003-4641-7541
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Dr. Loudella Calotes-Castillo
Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
https://orcid.org/0000-0002-7810-7209
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Dr. Rhea Salonga-Quimpo
Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, College of Medicine and Philippine General Hospital, University of the Philippines Manila
, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
https://orcid.org/0000-0002-2006-2861
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Congenital cytomegalovirus (cCMV) infection is a leading cause of neurologic disability in infants, often presenting with microcephaly, seizures, and sensorineural hearing loss. However, atypical manifestations such as macrocephaly and intracranial abscess are extremely rare.
We report a case of an infant presenting with progressive macrocephaly, with intracranial abscess and obstructive hydrocephalus. She had a history of prematurity and neonatal sepsis. Neuroimaging revealed a rim-enhancing lesion at the quadrigeminal cistern and aqueductal stenosis. Cerebrospinal fluid (CSF) analysis from ventricular tap showed signs of ventriculitis, and both serum and CSF tested positive for CMV IgG and IgM, associated with a high viral load. Antiviral and antibiotic therapy led to resolution of the abscess and ventriculitis. A ventriculoperitoneal shunt was subsequently placed.
This case illustrates a rare neurological complication of cCMV presenting with an intracranial abscess and hydrocephalus in an immunocompetent infant. It highlights the wide spectrum of cCMV manifestations and the challenges of diagnosis in settings without routine CMV screening. Early recognition and timely intervention are critical in improving outcomes, especially in low- and middle-income countries where systematic CMV testing is lacking.
Ryner Jose D. Carrillo, MD, MSc,
Abigail S. Salcedo, MD,
Jose Leonard R. Pascual V, MD,
Lina Rose A. Alcances, MD, MOH,
Kathryn Baltazar-Braganza, MD,
Karl Jeffrey E. Murillo, MD,
Marie Gene Cruz-Tantoco, MD,
Mark Dale S. Imbag, MD,
Ma. Theresa M. Collante, MD,
Charlotte Averill Y. Tan, MD,
Marquis Von Angelo Syquio Go Joson, MD,
Ma. Kriselda P. Alonzo,
Larissa Christia F. Adique, MClinAud,
Abigael C. Andal-Saniano, MD,
Jaymilyn V. Catangay-Ombao, MClinAud,
Maria Teresita S. Cucueco, MD, MOH,
Joanne Sebastiana M. De Ramos, MD, DHPEd,
Elmer M. Dela Cruz, EM, MD, MCIAud,
Jan Alexeis C. Lacuata, MD,
Cindy Canceko-Llego, MD, MSc,
Kimberly Mae C. Ong, MD, MSc,
Hubert D. Ramos,
Maria Rina T. Reyes-Quintos, MD, MClinAud, PhD,
Rosario R. Ricalde, MD,
Talitha Karisse L. Y Yarza, MClinAud,
Philippine Clinical Practice Guidelines for Periodic Health Examination: Screening for Hearing Disorders
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Acta Medica Philippina: Vol. 60 No. 10 (2026): National Practice Guidelines Program (NPGP) Issue 1: Periodic Health Examination (PHEX) Series