Can placenta assist in the diagnosis of congenital cytomegalovirosis?

Abstract

Introduction: Congenital cytomegalovirus is the main infectious cause of sensorineural hearing loss and abnormalities in neurological development in newborns in developed countries, second only to cerebral palsy among all causes of severe malformation in many parts of the world. When symptomatic, newborns may have microcephaly, hepatosplenomegaly, lethargy, petechiae, thrombocytopenia, neurological disabilities, retinopathy, and restricted intrauterine growth. Objective: To report a case of a newborn with suspected congenital cytomegalovirus infection and to document the placental findings. Case description: A newborn with restricted intrauterine growth, from a hypertensive mother with severe oligodramia, born by cesarean section, premature and small for gestational age. During prenatal care, we identified non-reactive anti-HIV, HBsAg and VDRL but cytomegalovirus-positive IgG and IgM. In the newborn, trans-fontanel ultrasound revealed grade II intracranial hemorrhage; computed tomography of the skull was normal; normal otoacoustic emission and IgG and IgM serology for cytomegalovirus were negative. There was no detection of cytomegalovirus DNA through the polymerase chain reaction in newborns’ cerebrospinal fluid and urine. Histopathology and immunohistochemistry of the placenta showed compatibility with viral infection by cytomegalovirus. Discussion: Intrauterine diagnosis of cytomegalovirus can be obtained by polymerase chain reaction in amniotic fluid. Postnatal diagnosis includes polymerase chain reaction in saliva, urine or both. Chronic lymphoplasmacytic villus, fibrotic avascular villus, intranuclear and intracytoplasmic inclusions are common and characteristic findings of cytomegalovirus placental infection. Anatomopathological study of the placenta is a valuable tool in presuming cases of congenital cytomegalovirus infection.