Hydrops and intrauterine fetal death associated with parvovirus B19 infection. case report

Abstract

Human parvovirus B19/B19V infection in pregnant women can be transmitted to the fetus and cause anemia, hydrops and fetal death in situations that are still poorly understood. Its clinical suspicion is important to request opportune studies in the mother and the fetus that can confirm the diagnosis (specific antibodies and viral DNA). A fatal case of hydrops fetalis associated with B19V infection is reported.

A 40-year-old patient with a controlled pregnancy (30 weeks of gestation). Consultation for not perceiving fetal movements. History of rheumatoid arthritis in remission (without treatment during pregnancy) and previous abortion (attributed to cytomegalovirus); receives alpha-methyldopa for pregnancy-induced hypertension with good evolution. Family history of systemic lupus erythematosus and scleroderma. She did not report rashes or previous parvoviral symptoms. Blood group 0 Rh+. Physical examination: blood pressure/BP 140-90mmHg, afebrile. Negative uterine dynamics (10 minutes), negative fetal heartbeat (doppler), closed cervix, intact amniotic membranes, negative genitorrhagia. Ultrasound: "single fetus died in utero, with pleural effusion, ascites and hydropic signs". A cesarean section was performed extracting a dead male fetus, with signs of maceration, weighing 1500g. Postoperative with good evolution. Discharge with analgesia and controls by obstetrics office, medical clinic and rheumatology. Pathological anatomy: "900g placenta, edematous chorionic villi, decreased villous capillaries with signs of moderate obliterative endarteritis; generalized edema attributable to hydrops." negative genetics. Maternal serum studies (2 months post-cesarean): indeterminate IgM-B19V=24.8IU/mL(cutoff/25), positive IgG-B19>50IU/mL(cutoff/3), positive PCR/B19V (limit detection) . Other negative TORCH results. IgM-CMV negative, IgG-CMV positive=709.5AU/mL(cutoff/6). In placenta: PCR/B19V negative.

A case of hydrops with fetal death related to B19V is reported. The timely collection of samples could improve the efficiency of diagnostic methods and the interpretation of results in cases of such great impact on health.