Late-onset Hemorrhagic Disease of the Newborn—An Unusual Presentation of Congenital Cytomegalovirus Infection: A Case Report

Background: Hemorrhagic disease of the newborn (HDN) is among the most common bleeding disorders in infancy and a significant cause of intracranial hemorrhage during the first year of life. If not promptly diagnosed and treated, it is associated with high morbidity and mortality. Case description: We present the case of a 3.9 kg female infant born at term (40 weeks' gestation) following an uncomplicated pregnancy and delivery. The healthy, unrelated parents reported no significant antenatal risk factors, infections, irradiation, or drug intake during pregnancy. At 43 days of age, the infant presented with a 2-day history of multiple ecchymotic patches over the body and active bleeding from ruptured sites. Clinical examination revealed hepatosplenomegaly, and TORCH screening confirmed congenital cytomegalovirus (CMV) positivity. Discussion: HDN, also referred to as vitamin K deficiency bleeding (VKDB), results from a deficiency in vitamin K and associated clotting factors (II, VII, IX, and X). The late-onset form, occurring between 2 and 12 weeks of life, poses significant risk due to its potential for intracranial bleeding. Congenital CMV infection, the most prevalent congenital infection globally, is typically asymptomatic but can present with petechiae, jaundice, hepatosplenomegaly, and neurological symptoms. It is a leading cause of sensorineural hearing loss and neurodevelopmental delays. In our case, late-onset HDN occurred secondary to congenital CMV infection, presenting with bleeding and hepatosplenomegaly. Conclusion: Late HDN is a rare but serious manifestation of congenital CMV infection. Early diagnosis and appropriate treatment are critical to avoid potentially severe complications such as intracranial bleeding and long-term neurological damage. How to cite this article: Choudhary P, Rani M. Late-onset Hemorrhagic Disease of the Newborn—An Unusual Presentation of Congenital Cytomegalovirus Infection: A Case Report. Pediatr Inf Dis 2025;7(4):144–146.