BACKGROUND: CMV remains a well-recognized cause of disease in the infant following intrauterine infection. It presents with symptomatic infections in about 10% of infected newborns while 90% of the infected infants will have no clinical manifestations of the infection in the newborn period

CASE CHARACTERISTICS: A 7 month old child presented with fever for 6 months. On history and clinical examination, the child was found to have delayed milestones, microcephaly and hepatosplenomegaly. Apart from this, the systemic examination was unremarkable. On workup, the child was found to have hypernatremia, polyuria, urine osmolality <300mosm/kg, and serum osmolality> 300mosm/kg. He also had elevated titres of CMV IgM, and urine PCR for CMV was positive.

FINAL DIAGNOSIS: Congenital CMV infection leading to Diabetes Insipidus. We gave the child Intranasal Desmopressin, and Oral Valgancyclovir. The fever responded, and the child was kept on follow-up.

CONCLUSION: Congenital CMV infection can present with a plethora of manifestations, and it is imperative to recognize them, given the need to follow these infants for the development of hearing loss in the future, and the effectiveness of Gancyclovir/Valgancyclovir in preventing it. Hearing loss develops in 11% of infected infants, and in some infants, hearing loss progresses during infancy.