Congenital Rubella Syndrome as a possible cause for persistent thrombocytopenia in early infancy: The Forgotten Culprit

Kumar, Jogender; Sundaram, Venkataseshan; Gupta, Kirti; Bhatia, Anmol; Kaur, Gurwinder; Dutta, Sourabh

doi:10.4322/acr.2021.386

Jogender Kumar

Post Graduate Institute of Medical Education & Research (PGIMER), Department of Pediatrics, Chandigarh, India

http://orcid.org/0000-0002-0464-9689

Venkataseshan Sundaram

Post Graduate Institute of Medical Education & Research (PGIMER), Department of Histopathology, Chandigarh, India

http://orcid.org/0000-0002-3135-8115

Kirti Gupta

Post Graduate Institute of Medical Education & Research (PGIMER), Department of Histopathology, Chandigarh, India

http://orcid.org/0000-0002-9999-3203

Anmol Bhatia

Post Graduate Institute of Medical Education & Research (PGIMER), Department of Radiodiagnosis, Chandigarh, India

http://orcid.org/0000-0003-4630-5742

Gurwinder Kaur

Post Graduate Institute of Medical Education & Research (PGIMER), Department of Histopathology, Chandigarh, India

http://orcid.org/0000-0002-1509-3938

Sourabh Dutta

Post Graduate Institute of Medical Education & Research (PGIMER), Department of Pediatrics, Chandigarh, India

http://orcid.org/0000-0002-5595-8289

Authors' contributions: Jogender Kumar: Managed the case, critically reviewed the literature, and drafted the manuscript. Venkataseshan Sundaram: Substantial inputs in the clinical analysis of the case; critically reviewed and edited the manuscript. Kirti Gupta: conceptualized the idea, performed the autopsy analysis, critically reviewed the literature, and drafted the pathological part of the manuscript. Anmol Bhatia: Substantial inputs in radiological analysis of the case; critically reviewed and edited the manuscript Gurwinder Kaur: Critically reviewed the literature and assisted in drafting the pathological part of the manuscript. Sourabh Dutta: Treating unit consultant, provided critical inputs in the manuscript draft and edited the manuscript. All authors have read and approved the manuscript.

Conflict of interest: There are no conflicts of interest.

CorrespondenceKirti Gupta Postgraduate Institute of Medical Education and Research (PGIMER), Department of Histopathology Sector 12, Zipcode: 160012, Chandigarh, India Phone: +91 (172) 2755105 / Fax: 0172-2744401kirtigupta10@yahoo.co.in

Workup	Result
Microbiology	Blood culture (Day 4, 10, 17 and Postmortem): sterile. Urine for fungal smear (Day 10 and 17): Negative. Cerebrospinal fluid (Day 4): Sugar- 41 mg/dl, Protein- 168 mg/dl, Cells- 120, all polymorphs. Gram-stain and culture - sterile. TORCH profile (Baby): Toxoplasmosis ELISA- IgG and IgM negative; Rubella chemiluminescence- IgM reactive; CMV chemiluminescence- nonreactive; Herpes Simplex ELISA- negative. TORCH profile (Mother): Toxoplasmosis ELISA- IgG and IgM negative; Rubella chemiluminescence- IgM nonreactive, IgG - reactive; CMV chemiluminescence- nonreactive; Herpes Simplex ELISA- negative
Immunology	Immunoglobulin profile: IgM < 11 mg/dL (40-160 mg/dL); IgG 786 mg/dL (300-900 mg/dL); IgA 61 mg/dL (15-70 mg/dL) HIV ELISA – Nonreactive Mother’s antinuclear antibody and antineutrophil cytoplasmic antibodies - Negative
Radiological	Chest X-ray (Day 1): Hyper inflated lungs with heterogeneous ill-defined infiltrates? Meconium aspiration syndrome. Chest X-ray (Day 17): Diffuse infiltrative opacification in the peripheral lung field? Interstitial pneumonitis Echocardiography: 3mm patent ductus arteriosus with small atrial septum defect. X-ray of Long bones- normal, no metaphysitis or radioulnar synostosis. Ultrasound of abdomen and pelvis: Cystic dysplasia of right kidney with loss of corticomedullary differentiation, and mild hydroureteronephrosis of the right kidney. Ultrasound cranium: Few echogenic foci in bilateral basal ganglia? Calcification
Eye evaluation	(day 5)- No cataract or chorioretinitis. Day 21- Sutural cataract and Fundus couldn’t be visualized
Platelet counts	4000/µL on day 3, 16000/µL on day 5, 21000/µL on day 7, 60000/µL on day 14, 46000/µL on day 21, and 34000/µL on day 29 of life.

[1] Authors' contributions: Jogender Kumar: Managed the case, critically reviewed the literature, and drafted the manuscript. Venkataseshan Sundaram: Substantial inputs in the clinical analysis of the case; critically reviewed and edited the manuscript. Kirti Gupta: conceptualized the idea, performed the autopsy analysis, critically reviewed the literature, and drafted the pathological part of the manuscript. Anmol Bhatia: Substantial inputs in radiological analysis of the case; critically reviewed and edited the manuscript Gurwinder Kaur: Critically reviewed the literature and assisted in drafting the pathological part of the manuscript. Sourabh Dutta: Treating unit consultant, provided critical inputs in the manuscript draft and edited the manuscript. All authors have read and approved the manuscript.

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Congenital Rubella Syndrome as a possible cause for persistent thrombocytopenia in early infancy: The Forgotten Culprit

Abstract