CONGENITAL LYMPHOCYTIC CHORIOMENINGITIS VIRUS SYNDROME - A DISEASE THAT MIMICS CONGENITAL TOXOPLASMOSIS OR CYTOMEGALOVIRUS-INFECTION

Objective. To describe the clinical characteristics of intrauterine in fection with lymphocytic choriomeningitis (LCM) virus, an uncommonly r ecognized cause of congenital viral infection. Patients. Three infants born in the midwestern United States in 1994 and 1995 with clinical f eatures and serologic studies consistent with congenital LCM virus inf ection and cases of congenital infection identified by review of the m edical literature between 1955 and 1996. Results. Twenty-six infants w ith serologically confirmed congenital LCM virus infection were identi fied. Twenty-two infants were products of term gestations, and birth w eights ranged from 2384 to 4400 g (median, 3520 g). Ocular abnormaliti es, macrocephaly, or microcephaly were the most commonly identified ne onatal features. Twenty-one infants (88%) had chorioretinopathy, 10 (4 3%) had macrocephaly (head circumference >90th percentile) at birth, a nd 3 (13%) were microcephalic (head circumference <10th percentile). M acrocephaly and hydrocephalus developed postnatally in one of the latt er infants. Hydrocephalus or intracranial calcifications were document ed in five infants by computed tomography or magnetic resonance imagin g. Nine infants (35%) died, and 10 (63%) of the 16 reported survivors had severe neurologic sequelae, consisting of spastic quadriparesis, s eizures, visual loss, or mental retardation. One-half of the mothers r eported illnesses compatible with LCM virus infection, and 25% reporte d exposures to rodents during their pregnancies. Conclusions. These ca ses suggest that congenital LCM virus infection could be an underrecog nized cause of congenital infection among infants born in the United S tates. Because of the clinical similarities of these congenital infect ions, cases of congenital LCM virus infection can be confused with inf ections with cytomegalovirus or Toxoplasma gondii.