Pediatrics

Congenital cytomegalovirus infection (cCMV) is the most common congenital viral infection, with a consistent rate of morbidity, mortality, and long-term sequelae, especially in the case of late diagnosis. Nevertheless, a universal screening for CMV is not currently recommended, and global awareness about this infection, as well as accurate and shared indications on follow-up and treatment, are still lacking. We reviewed data about 59 suspect cCMV cases who referred to our center from 2014 to 2021. We report 41 cases of confirmed cCMV diagnosed at birth, with clinical or radiological abnormalities in 36.6% of them. Other five patients received a late diagnosis and all presented neurological impairment. Twelve patients received therapy with Valganciclovir within the first month of life, with favorable outcome in nine cases. Therapy after the first month of life was attempted in four patients, with improvement in one case. The overall awareness about cCMV infection was 32.6%. Consideri...

Objective. Congenital adrenal hyperplasia (CAH) is the most common cause of adrenal insufficiency in pediatrics. Chronic glucocorticoid replacement is the mainstay of treatment in the classic forms of CAH, and mineralocorticoid replacement therapy is mandatory in the salt-wasting form. Fasting is a mild stressor, which can expose to dehydration, hypotension, hypoglycemia, and acute adrenal crisis in patients with adrenal insufficiency. Case. We report the case of an adolescent affected by the classic form with salt-losing CAH, who observed Ramadan for 30 days, without individualized therapeutic management plan. After Ramadan, a dramatic increase of ACTH level (1081 pg/ml, n.v. 6–57), reduced cortisolemia, tendency to hypotension, and weight loss were recorded. She experienced insomnia, intense thirst, asthenia, and headache. The symptoms disappeared restarting the previous therapy schedule and increasing the total hydrocortisone daily dose with progressive restoring of hormonal cont...