To the Editor: Cytomegalovirus (CMV) infection in preterm neonates may clinically present with symptoms of various organs [1]. Here, the possible association of acquired central hypothyroidism with CMV infection was explored in an extremely preterm infant.

A preterm [Gestational age (GA) 27 wk, birth weight (BW) of 870 g, appropriate for gestational age (AGA) with normal head circumference- 25 cm] baby girl was vaginally delivered with a normal APGAR score. The baby had respiratory distress syndrome immediately after birth and had late-onset fungal sepsis during the second week of age. She received two units of packed-RBC transfusions during her hospital stay and was fed on her mother’s own milk. At 60 d of age, the baby had abdominal fullness and was found to have splenomegaly (5 cm below the left costal margin). She had conjugated hyperbilirubinemia (total serum bilirubin 5.22 g/dL, direct bilirubin 3.2 g/dL, SGOT- 177 U/L, SGPT- 50 U/L) and severe thrombocytopenia (23,000 cells/cc). CMV DNA-PCR detected 3,24,000 copies/mL in the urine sample. Ophthalmological examination was normal and cranial ultrasound revealed bilateral cysts in the caudothalamic groove. Her FT4- 1.4 ng/dL and TSH- 4.6 mIU/L on day 6 were normal, and repeat FT4- 0.86 ng/dL and TSH- 5.5 mIU/L on day 65 of age. Adrenal function evaluation showed hypocortisolism (serum cortisol- 3 ng/dL).

This CMV-infected neonate had central hypothyroidism with adrenal insufficiency and required thyroxine and corticosteroid supplementation with antiviral medication [2]. The association of congenital CMV infection with congenital hypothyroidism was reported in a previous case report, possibly due to affection of thyrocytes [3]. In a case report, CMV infection with central hypothyroidism was detected at 4 mo of age in a term-born neonate [4]. To our knowledge, no data on the association of CMV infection with acquired central hypothyroidism has been reported in preterm babies. Hence, a thyroid function evaluation may be ordered in neonates with CMV infection.