CASE1-
You are called to examine a 1-day-old male because the nurse is concerned that he is jaundiced. He was born by spontaneous vaginal delivery to a 19-year-old gravida, para, after a full-term, uncomplicated pregnancy. The mother had no illnesses during his pregnancy; she did not use tobacco, alcohol, or drugs; and the only medication she took prenatal vitamins. She denied any significant medical history, and there is no family history of genetic syndromes or illnesses among children. The infant is mildly jaundiced but has no notable abnormally small head circumference (microcephaly). His cardiovascular examination is normal. His liver and spleen are enlarged on palpation of the abdomen. Neurologic exam is notable for the lack of a startle response to a loud noise. CT scan of his head reveals intracerebral calcifications. The pediatrician explains to the child’s mother that the virus involved is the most commonly transmitted transplacental viral infection in the United States.
a. What is the most likely cause of this infant’s condition?

The most likely cause of this infant’s condition is a congenital infection with cytomegalovirus. Signs of enlargement of the liver and spleen, deafness, and no signs of other clinical diseases are some of the reasons to suspect CMV as the most likely cause of the infant’s illness.

Cytomegalovirus, or CMV is a virus that produces infections in people who are immunosuppressed and is also one of the most commonly known infection that is transplacentally transmitted.

b. How did he likely acquire this?

The infant most likely acquired CMV transplacentally when the mother was infected with CMV during pregnancy. There is a higher risk if the mother had a primary infection while pregnant.

Some of the likely ways the mother might have been infected with CMV are transmission of the virus through blood, oral secretion, sexual contact, or congenital infection as well.

c. What is the test of choice to confirm the diagnosis?
A urine test can be done to confirm the diagnosis. If the CMV is present in the suspected patient’s urine, the diagnosis can be confirmed.
d. How is this infection treated?

Treatments for CMV infections include drugs such as ganciclovir, immune globulin plus ganciclovir, or foscarnet. Ganciclovir is known to be used for patients with HIV in order to prevent CMV, while immune globulin and ganciclovir is known to be used for bone marrow transplant patients in reducing the high mortality of CMV pneumonia.

CASE 2-

A 28 yr old man presents to the office for evaluation of a rash on his chest. He started with one oval shaped purplish areas that he thought was a bruise but has subsequently developed new multiple lesions. The growths don’t hurt, itch or bleed, but he continues to get new ones, and the existing ones are getting larger. He has never had anything like this before, has no history of allergies and denies exposure to any new medications, foods, lotions, or