A case of symptomatic congenital cytomegalovirus infection treated with prenatal intraperitoneal immunoglobulin administration

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  • INABA Kanako
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • SATO Yukiyasu
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • TAKAI Hiroshi
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • KAKUI Kazuyo
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • TATSUMI Keiji
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • FUJIWARA Hiroshi
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • KAWAI Masahiko
    Department of Pediatrics, Kyoto University Graduate School of Medicine
  • KODAMA Dan
    Department of Pediatrics, Kyoto University Graduate School of Medicine
  • MINEMATSU Toshio
    Research Center for Disease Control, Aisenkai Nichinan Hospital
  • YAMADA Hideto
    Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine
  • KONISHI Ikuo
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine

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Other Title
  • 免疫グロブリンの胎児腹腔内投与を施行した先天性サイトメガロウイルス感染の１例
  • 症例報告 免疫グロブリンの胎児腹腔内投与を施行した先天性サイトメガロウイルス感染の1例
  • ショウレイ ホウコク メンエキ グロブリン ノ タイジ フククウ ナイ トウヨ オ シコウ シタ センテンセイ サイトメガロウイルス カンセン ノ 1レイ

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Abstract

Among women with primary cytomegalovirus (CMV) infection during pregnancy, the rate of vertical transmission is approximately 40%. The congenital CMV infection (CCMVI) causes symptoms such as intrauterine growth restriction, hepatosplenomegaly, microcephaly, and ascites in approximately 10% of the infected fetuses. Here, we describe a case of symptomatic CCMVI that was treated with prenatal intraperitoneal immunoglobulin injection. A 19-year-old woman in the 21st week of pregnancy presented to our hospital with massive fetal ascites and severe oligohydramnios. She was diagnosed with symptomatic CCMVI due to the presence of CMV-DNA in both the amniotic fluid and the fetal ascites. After two biweekly administrations of immunoglobulin into the fetal peritoneal cavity, CMV-DNA in the fetal ascites as well as amount of the fetal ascites was decreased. The patient vaginally delivered a female baby weighing 2034g at 37 weeks of gestation. At birth, the neonate showed hepatosplenomegaly and thrombocytopenia with petechiae throughout the abdomen. Her urine CMV-DNA was positive. Intravenous immunoglobulin followed by ganciclovir administration eradicated these symptoms and her urine CMV-DNA became negative. However, examination of the auditory brainstem response suggested moderate hearing impairment of the right ear. This case study showed that prenatal intraperitoneal administration of immunoglobulin could ameliorate symptoms in the affected fetus. [Adv Obstet Gynecol, 62 (3) :234-240, 2010 (H22.8)]

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