Neonatal aortic arch thrombosis as a result of congenital cytomegalovirus infection

Thrombotic disease is rare in neonates. The main risk factors at this age a re perinatal asphyxia, maternal diabetes, sepsis, polycythemia, dehydration , a low cardiac output, and in primis the catheterization of central lines. Another important risk factor is inherited thrombophilia. Arterial thrombo sis is even more rare than venous thrombosis and less related to most of th e risk factors listed above; it occurs more frequently in the iliac, femora l, and cerebral arteries but very rarely in the aorta. Most of the describe d cases of aortic thrombosis are associated with the catheterization of an umbilical artery and involve the descending tract and the renal arteries; v ery few relate to the ascending tract and the aortic arch. The possible rol e of virus-induced primary vascular endothelium damage in the etiopathogene sis of neonatal arterial thrombosis has been previously hypothesized. Herpe sviruses, particularly human cytomegalovirus (HCMV), can infect endothelial cells and directly damage intact vascular endothelium, altering its thromb oresistant surface as a result of procoagulant activity mediated by specifi c viral surface phospholipids, necessary for the coagulation enzyme complex assembly that leads to thrombin generation. We describe a case of congenit al aortic arch thrombosis. The clinical, laboratory, and virologic pictures ; the anatomopathologic findings (fully compatible with viral infection); t he detection of HCMV in various tissues (including the aorta); and the abse nce of other causes of aortic thrombosis make it possible to attribute the case to a severe congenital HCMV infection with multiple organ involvement, after the primary infection of the mother. The hemostatic system disorders and hemodynamic disturbances related to viral cardiac damage explain the c linical features of the case and indicate that congenital HCMV infection sh ould be included among the causes of neonatal aortic thrombosis.