Fetal cytomegalovirus infection

Case contributed by Dr Fabien Ho

Presentation

Routine 2nd trimester screening

Patient Data

Age: 24 weeks gestation
Ultrasound

Sagittal images and videos showed numerous bright echogenic thick foci on the ventricular walls as well as alongside the thalamocaudate groove, including the thalami.

There was mild ventricular dilation as well as subjective enlargement of the pericerebral spaces.
In addition, the corpus callosum appeared shortened: 16mm at 24WG (<3rd percentile at 24WG according to Pashaj et al. UOG 2013; 25mm marking the 50th percentile).
These 2 elements may suggest associated white matter loss.
Cerebellum biometry was also abnormal, corresponding to the 50th percentile of 19WG.
The morphology of the sylvian fissure seemed closer to 22WG than 24WG.

In addition the bowel was hyperechoic, and hands were crisped as in clinodactyly configuration (1st and 5th digits extended while other digits flexed).

There was no elements suggesting fetal anemia (MCA velocimetry was normal, no cardiomegaly). We did not witness brain cysts, especially near the frontal and temporal horns.

Case Discussion

All these elements led us to look out for infectious fetopathy as the most likely diagnosis to ascertain first.
We performed an amniocentesis and PCR testing for CytoMegaloVirus was positive. PCR for parvovirus B19, Herpes Simplex Virus were negative.
Serologies for toxoplasmosis, rubeola, syphilis were also negative.
Therefore our diagnosis was CMV-induced fetopathy.

Case published with Dr Fabrice Cuillier.

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Case information

rID: 65098
Published: 23rd Dec 2018
Last edited: 14th Aug 2019
System: Obstetrics
Inclusion in quiz mode: Included
Institution: CHU de la Reunion

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