Diagnostic challenges in congenital cytomegalovirus infection in pregnancy: A case report

Abstract

Cytomegalovirus is the most common congenital viral infection. Infection can cause developmental delay, sensorineural deafness and fetal death. Fetal damage is more severe when infection occurs in the first trimester of pregnancy. Prenatal ultrasound findings may be cerebral, such as ventriculomegaly, microcephaly and periventricular leukomalacia, as well as non-cerebral, such as echogenic bowel, ascites and pericardial effusion. We present a case of congenital cytomegalovirus infection in which the only ultrasound sign noted at routine second-trimester scan was low-grade echogenic bowel, a soft marker, which progressed to severe disease in the third trimester, when further investigation was prompted, leading to the diagnosis. Patients need to be counselled regarding the possible perinatal prognosis. Ultrasound markers can often but not always predict severity and, hence, counselling can be a challenge. Conclusion: A meticulous anatomy survey in mid-trimester remains the norm and ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy.

Keywords: Congenital cytomegalovirus infection; Fetal hydrops; Fetal pericardial effusion; IgG avidity.

Fig. 1

Low-grade echogenic bowel noted at morphology scan (19w5d).

Fig. 2

Fetal hydrops noted at growth scan (30wk6d). Gross fetal ascites in transverse view of abdomen.

Fig. 3

Fetal hydrops noted at growth scan (30wk6d). Bilateral pericardial effusion in transverse view of the fetal chest.

Fig. 4

Fetal hydrops noted at growth scan (30wk6d). Lateral ventricles of fetal brain measuring 12 mm showing ventriculomegaly.

Fig. 5

Fetal hydrops noted at growth scan (30wk6d). Middle cerebral artery (MCA) Doppler showing high peak systolic velocity (PSV) measuring >1.5 MoM: 94.46 cm/s; Right MCA Systolic/diastolic (S/D): 3.99; Right MCA Pulsatility Index (PI): 1.38; Right MCA Resistance Index (RI): 0.75; Right MCA heart rate: 121 beats/min.