Review Question - QID 214720

A 2-day-old boy has a 1-minute generalized seizure in the newborn nursery. Prior to this, he was lethargic, had difficulty feeding, and vomited several times. He was born at 37 weeks gestational age to a 29-year-old woman via an uncomplicated vaginal delivery. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The pregnancy was uncomplicated other than a 1-week episode of low-grade fever and swollen lymph nodes early in the pregnancy. Medications during pregnancy included folic acid and a multivitamin. The mother is up to date on all immunizations. His temperature is 98.6°F (37.0°C), blood pressure is 60/40 mmHg, pulse is 140/min, and respirations are 42/min. The infant is at the 99th percentile for head circumference, 15th percentile for length, and 15th percentile for weight. On physical examination, the infant appears jaundiced, and there are several purpuric lesions on his trunk and extremities. The fundoscopic exam is shown in Figure A. The infant fails his hearing test. A CT scan shows ventricular dilation and diffuse intracranial calcifications. Which of the following congenital infections is the most likely diagnosis?