Congenital rubella syndrome with death from interstitial pneumonia

Abstract

There was a rubella epidemic in Japan in 2012-2013, which led to an increased number infants being born with congenital rubella syndrome (CRS). Symptoms of CRS are varied and include cataracts, congenital heart disease, and hearing impairment, but case reports of CRS complicated by interstitial pneumonia are rare. We report the case of a patient with CRS who died of respiratory failure caused by interstitial pneumonia. Thrombocytopenia had been present for approximately 1 month after birth, and the patient presented with sudden lung hemorrhage at 64 days old. Thereafter, respiratory condition deteriorated, and the patient died at 107 days old. Given that infants with CRS who have thrombocytopenia and interstitial pneumonia have a high risk of death, they should be monitored carefully for potential complications.

Anti-Jo-1 Antibody-positive Interstitial Pneumonia in an Elderly Patient with Congenital Rubella Syndrome

“…Interstitial pneumonia is an uncommon complication of CRS. Mizuno et al summarized reports of 13 infants with interstitial pneumonia associated with CRS including one that they experienced (6). Only four of these 13 infants survived, indicating that the prognosis for interstitial pneumonia associated with CRS is poor.…”

“…Manifestations of CRS include hearing impairment, cataracts, congenital heart diseases such as pulmonary stenosis and persistent ductus arteriosus and mental retardation (1,2). In addition, interstitial pneumonia arising in infants with CRS has been reported (3)(4)(5)(6). However, interstitial pneumonia in an adult patient with CRS has never been reported as far as we can ascertain.…”

Rubella (German measles) revisited

“…These include prematurity, intrauterine growth retardation, microcephaly, haemolytic anaemia, thrombocytopenia, purpuric rash, jaundice, hepatitis, hepatomegaly, splenomegaly, "blueberry muffin" spots (sites of dermal erythropoiesis, Figs 4 and 5), hypotonia, bulging anterior fontanelle, constricted maxillary arch, high palate, interstitial pneumonia, myocarditis, myositis, nephritis, meningoencephalitis, and striated radiolucencies in the long bone ("celery stalk" lesions). 4,7,25,[30][31][32][33][34][35] Many of these features are transient and may resolve spontaneously over days or weeks. 25 Delayed manifestations, in addition to sensorineural hearing impairment, include mental retardation, psychomotor retardation, speech delay, attention deficit hyperactivity syndrome, autism, behavioural disorders, progressive encephalopathy, insulin-dependent diabetes mellitus, thyroid dysfunction (hypothyroidism, hyperthyroidism, thyroiditis), Addison disease, growth hormone deficiency, and immunological defects.…”

“…Infants with thrombocytopenia, hepatosplenomegaly, interstitial pneumonia, and pulmonary hypertension have a high risk of mortality. 34,47 Of those who develop thrombocytopenia and hepatosplenomegaly in the neonatal period, approximately 15% die within the first year of life. 3…”

Clinical manifestations of congenital rubella syndrome: A review of our experience in Vietnam

“…Late-onset interstitial pneumonitis has been detected at the age of 3-12 months and led to death in some cases [6,26,73]. Progressive rubella panencephalitis, a slowly progressive disease of the central nervous system that is due to chronic rubella virus infection of the brain, rarely manifests during the second decade of life among patients with CRS [6].…”