# Prolonged Indirect Hyperbilirubinemia as a Manifestation of Postnatally Acquired Cytomegalovirus Infection

## TL;DR

A two-month-old infant with prolonged jaundice was found to have a postnatally acquired CMV infection, highlighting its rare but possible presentation as indirect hyperbilirubinemia.

## Contribution

This case report adds to the understanding of CMV infection presenting as prolonged indirect hyperbilirubinemia in infants.

## Key findings

- A two-month-old infant presented with prolonged indirect hyperbilirubinemia and neutropenia.
- CMV infection was confirmed via PCR at three months, despite a negative Guthrie card test at three days.
- The case suggests CMV can manifest as isolated prolonged indirect jaundice in infants.

## Abstract

Prolonged neonatal jaundice is defined as jaundice lasting more than 14 days. Cytomegalovirus (CMV) is a ubiquitous pathogen that may present in young infants as a postnatally acquired infection, frequently transmitted through breast milk.

We report the case of a two-month-old infant who presented with prolonged indirect hyperbilirubinemia (no other relevant hepatic alterations) associated with neutropenia. Abdominal ultrasound and Gilbert syndrome testing were unremarkable. Polymerase chain reaction (PCR) testing for CMV in urine was positive at three months of age, while the Guthrie card blood sample testing, taken at three days of age, was negative.

Postnatally acquired CMV infection is frequently asymptomatic in immunocompetent infants, although it may manifest with prolonged hyperbilirubinemia and transient hepatic enzyme elevation. In literature, it is more commonly associated with conjugated hyperbilirubinemia. This case highlights the importance of considering CMV infection as a potential cause of isolated prolonged indirect jaundice, as well as emphasizing its typically benign course and prognosis.