Approach to leukocoria (pediatrics) Quiz: Ace Your Exams

A newborn boy delivered at 36 weeks’ gestation is evaluated in the nursery. The infant is small for gestational age. Prenatal care was inconsistent, but there is no history of drug use or teratogen exposure. The parent recalls having a “cold” early in the pregnancy and is unsure if she received her childhood vaccinations. Delivery was uneventful, and Apgar scores were 6 and 8 at 1 and 5 minutes, respectively. Temperature is 37°C (98.6°F), pulse is 170/min, respirations are 42/min, blood pressure is 72/38 mm Hg, and oxygen saturation is 99% on room air. On physical examination, multiple violaceous macules are noted on the skin. No dysmorphic features are present. Cardiac auscultation reveals a continuous, machine-like murmur. Ophthalmologic evaluation shows a bilateral blue-grey pupillary reflex with lens opacities. Which of the following is the most probable cause of the ophthalmological findings in this patient?