Background: Symptoms of congenital cytomegalovirus infection remains unclear.
Case characteristics: Extremely low birth weight twins with twin-to-twin transfusion syndrome were infected with cytomegalovirus congenitally.
Observation: The donor showed neuronal impairment, whereas the recipient showed hepatic dysfunction.
Message: Intrauterine hemodynamics may be important in pathophysiology of congenital cytomegalovirus infection.