2012445559 55 Valganciclovir 1 CMVvalganciclovirVGCV 1 21 5 CMV IgM CMV-DNA CMV 34 VGCV 2 1 CMV CMV ganciclovirvalganciclovir MRI cytomegalovirus; CMV TORCH CMV 1 CMV valganciclovirvgcv 21 2 1 1 2 23 37 4 2,856 gappropriate for dates; AFD 48 cm 35 cm 5 refer 11 auditory brain response; ABRauditory steady-state response; ASSR MRI * 1ab 21 21 51 cm0.95sd 3,280 g0.70sd 35 cm1.21sd MRI CMV-DNA PCR CMV CMV-DNA 1 ganciclovirgcvvgcv VGCV 2 34 6 VGCV 16 mg/kg2 1 CMV CMV 1 2 CMV 6 55
56 44 1 A B a C D E b F G H c 1 MRI a 11 ABFLAIR TI:2300 msectr:8320 msecte:90 msec b 3 VGCV1 CDFLAIR TI:2500 msectr:9000 msecte:137 msec ET1 TR:494 msecte:12 msec c 11 VGCV2 FGFLAIR TI:2300 msectr:9000 msecte:137 msec HT1 TR:562 msecte:12 msec * T2 * VGCV :valganciclovir 1 W 21 WBC 10600 /l Neut 19.3 % Lymph 68.1 % RBC 373 /l Hb 11.7 g/dl Plt 29.3 /l 21 AST 35 U/l ALT 21 U/l LD 305 U/l T-BIL 0.54 mg/dl BUN 0.54 mg/dl Cre 0.20 mg/dl Na 139 meq/l Cl 105 meq/l K 5.9 meq/l CRP 0.3 mg/dl 21 CMV-IgM Toxoplasma IgG CMV-DNA CMV-DNA 33 Glu 34 mg/dl Cl 119 meq/l TP 85 mg/dl 18 /l CMV-DNA 56
2012 1 57 copies/ml 100,000,000,000 VGCV 6 511 10,000,000,000 VGCV 6 1420 1,000,000,000 C M V 100,000,000 10,000,000 1,000,000 100,000 10,000 1,000 100 5 7 9 11 13 15 17 19 21 23 25 27 29 31 2CMV CMV CMV-DNA 1 500copies/mL CMV :cytomegalovirusvgcv:valganciclovir CMV 500copies/mL 1 2 2 24 CMV-DNA MRI * 3 4 CT 11 MRI T2 FLAIR CMV 1ch MRI 1 3 10 ABR 3 CMV 0.4 0.5% 10% 10 15% CMV 0.4 0.5% 20% 1,000 1 CMV 3 35 65% 4 10 60% CMV 5 CMV CMV 30 Guthrie DNA CMV 2003 Kimberlin CMV GCV 6 1 6 GCV VGCV GCV 7 2008 2 VGCV CMV 89 evidence 34 VGCV GCV 57
58 44 1 a b c 0.1V 0.2V 0.2V 2 3 4 5 ms 6 2 3 4 5 6 ms 2 3 4 5 ms 6 7 8 9 10 7 8 9 10 a 32 b 5 VGCV2 c 10 0.5V 0.5V 0.2V 2 3 4 5 6 7 8 9 10 80dB 70dB 60dB 2 3 4 5 ms 6 7 8 9 10 70dB 60dB 50dB 7 8 9 10 2 3 4 5 6 7 8 9 10 ms 3 ADL VGCV VGCV CMV VGCV GCVVGCV 10 1 2002 ;32 : 878-80. 2 CMV 21 2009 07 16 http ://mhlw-grants.niph.go.jp/niph/ search/nisr00.do 3 2009 ;50 : 103-12. 4Revello MG, Gerna G. Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant. Clin Microbiol Rev 2002 ;15 :680-715. 5Cheeran MC, Lokensgard JR, Schleiss MR. Neuropathogenesis of congenital cytomegalovirus infection :disease mechanisms and prospects for intervention. Clin Microbiol Rev 2009 ;22 :99-126. 6Kimberlin DW, Lin CY, Sanchez PJ, et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system :a randomized, controlled trial. J Pediatr 2003 ;143 :16-25. 7Kimberlin DW, Acosta EP, Sanchez PJ, et al. Pharmacokinetic and pharmacodynamic assessment of oral valganciclovir in the treatment of symptomatic congenital cytomegalovirus disease. J Infect Dis 2008 ;197 : 863-45. 8Schulzke S, Buhrer C. Valganciclovir for treatment of congenital cytomegalovirus infection. Eur J Pediatr 2006 ;165 :575-6. 9Lombardi G, Garofoli F, Villani P, et al. Oral valganciclovir treat- 58
2012 1 59 ment in newborns with symptomatic congenital cytomegalovirus infection. Eur J Clin Microbiol Infect Dis 2009 ;28 :1465-70. 10Kashiwagi Y, Kawashima H, Nakajima J, et al. Efficacy of prolonged valganciclovir therapy for congenital cytomegalovirus infection. J Infect Chemother 2011 ;17 :538-40. Successful Treatment of Congenital Cytomegalovirus Infection with Valganciclovir Yu Ishida, MD, Tasuku Miyajima, MD, Masaru Shimura, MD, Shinichiro Morichi, MD, Yasuyuki Morishima, MD, Hiroaki Ioi, MD, Shingo Oana, MD, Gaku Yamanaka, MD, Hisashi Kawashima, MD and Akinori Hoshika, MD Department of Pediatrics, Tokyo Medical University, Tokyo Congenital cytomegaloviruscmvinfection occurs frequently in neonates. However, there are no screening tests or definitive treatments for this infection in Japan. We report a case of a 21-day-old Japanese boy with congenital CMV infection. He was referred to our hospital for treatment of congenital bilateral deafness. Brain magnetic resonance imagingmrirevealed cortical dysplasia of the temporal poles, enlarged ventricles, and areas of abnormal intensity in the white matter. He was given a diagnosis of congenital CMV infection based on the detection of CMV DNA in his urine and the umbilical cord. After the administration of valganciclovir, no CMV DNA was detected in his serum, and brain MRI and electroencephalogram findings, motor development, and deafness improved. Further investigation is needed to establish a screening test and treatment for congenital CMV infection in Japan. No To Hattatsu 2012 ;44 : 55-9 59