A Newborn Boy Is Being Evaluated in the Nursery

A newborn boy is being evaluated in the nursery.  He was born via normal spontaneous vaginal delivery with no complications.  His mother did not receive prenatal care during pregnancy, and the estimated gestational age by her last menstrual period is 39 weeks.  The infant has a weight of 2.4 kg (5 lb, 3 oz, 1st percentile) , length of 46 cm (18 in, 2nd percentile) , and head circumference of 32 cm (12.6 in, 2nd percentile) .  Physical examination shows a nondysmorphic, small for gestational age infant with several nonblanching, purpuric lesions over his trunk, face, and extremities.  Red reflex is absent bilaterally.  Cardiac examination reveals a continuous murmur that is loudest over the left infraclavicular region, and an enlarged spleen and liver are palpated in the abdomen.  The patient fails the newborn hearing test bilaterally.  Head ultrasound is normal.  Which of the following is the most likely diagnosis for this patient?

A) Cytomegalovirus
B) Herpes simplex virus
C) Rubella
D) Syphilis
E) Toxoplasmosis

Correct Answer:

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