Cytomegalovirus Infection in Twin Pregnancy and Coincidence of Type I Tyrosinemia in One of Twins

Background: Cytomegalovirus (CMV) is the most common cause of congenital infection. Although most of the involved neonates are asymptomatic but virus can cause a range of problems from mild to severe illness with involvement of different organs like central nervous system, gastrointestinal and liver. Proneness to CMV is very high (up to 1% of neonates). In the other hand trosinemia type I is a rare metabolic disorder with involvement of liver, neurologic, bone and other organs.
Case Presentation: A 3-month-old infant, product of twin pregnancy was hospitalized because of jaundice, FTT, hepatomegaly and sepsis. The other twin showed normal growth with no problems. Work up for cholestasis and FTT was suggestive of two different entities. Polymerase chain reaction for CMV in liver tissue and serum was positive. Meanwhile laboratory findings for metabolic disorder led to the diagnosis of type 1 tyrosinemia. The other twin was infected with CMV too.
Conclusion: Although coexistence of two causes for cholestasis is very rare, it is sometimes necessary to study more to rule out other entities like metabolic disease including tyrosinemia (if any symptoms exist).