ESPE Abstracts (2014) 82 P-D-3-1-910

Central Diabetes Insipidus Caused by Congenital Cytomegalovirus: a Rare Association?

Tiago Jeronimo dos Santos, Caroline Passone, Leandra Steinmetz, Louise Cominato, Hilton Kuperman, Thaís Della Manna, Hamilton Menezes Filho, Vaê Dichtchekenian, Joyce Pupo, Nuvarte Setian & Durval Damiani

Instituto da Criança, HCFMUSP, São Paulo, São Paulo, Brazil

Introduction: Central diabetes insipidus (CDI) is a condition in which large volumes of diluted urine are excreted due to vasopressin deficiency. In most patients, DI is caused by the destruction of neurons in the hypothalamus and the known causes include local inflammation or autoimmune aggression, vascular and infiltrative diseases, as well as compressive masses, trauma or midline cranial malformations. CDI caused by cytomegalovirus (CMV) infection is a very rare condition.

Case Report: A Brazilian 5-month-old boy, with failure to thrive, was referred due to intermittent fever, polyuria, and hypotonia. His mother was infected by cmv in the first trimester of pregnancy. Neither the mother nor the child was treated. A cranium CT was performed showing scattered intracranial calcifications, mainly in white matter and periventricular region. CMV serum PCR was positive (162 virus samples/ml). Abdominal ultrasound showed mild hepatosplenomegaly. Fundoscopy was normal, and, in auditory evocated potential, a sensorial loss in the left ear was found. Lab work-up: serum Na 155 mEq/l (135–145), serum osmolality 307 mOsm/kg (285–310), and urinary osmolality 82 mOsm/kg (50–1400). Other hypothalamic–pituitary hormone dysfunctions have been excluded. A brain MRI showed loss of hypersignal (T1-weighted) in the posterior lobe of pituitary gland; and high intensity signal (T2) on perivascular space and caudate nucleus, corresponding to calcifications. Desmopressin treatment was started. One month later, neurodevelopment and ponderal improvement, as well as adequate serum and urinary osmolality, without polyuria, were achieved.

Conclusion: CMV infection is a rare association with CDI in infants. Therefore, in infants with failure to thrive, associated to maternal infectious diseases during the pregnancy, attention about their osmolality should be given due to the difficulties to notice DI symptomatology in these patients.