Reactions 1680, p282 - 2 Dec 2017 Congenital cytomegalovirus infection following in utero exposure and Guillain Barre syndrome with cytomegalovirus infection: 2 case reports A 30-year-old woman developed Guillain Barre syndrome (GBS) and cytomegalovirus (CMV) infection during pregnancy following treatment with prednisone. Subsequently, her foetus [sex not stated] developed fatal congenital CMV infection following in utero exposure to prednisone [route and duration of treatment to reaction onsets not stated]. The woman was admitted to hospital with the complaints of paraesthesia, numbness and progressive symmetric ascending weakness in the legs associated with difficulty in walking. She th had undergone in-vitro fertilisation and was in the 10 week of th pregnancy and 12 week of amenorrhoea. Her history included a spontaneous abortion. She also had weakly positive antinuclear antibodies. Consequently, she received th prednisone 0.3 mg/kg/day till the 12 week of amenorrhoea. Ten days before the onset of neurological symptoms, she developed flu-like infection. Deep tendon reflexes were absent in the lower and upper limbs and were revealed by clinical examination. Elevated protein concentration was observed in the cerebrospinal fluid (CSF) specimen. Based on the CSF examination, electrophysiological studies and clinical signs, a diagnosis of GBS in the acute inflammatory demyelinating polyradiculoneuropathy was made. She received high dose standard immune globulin[Ivig; Tegeline] on day 2 of the hospitalisation. She was transferred to the ICU. She received parenteral nutrition due to difficulty in swallowing. She also developed left-sided palsy on day 5. Prophylactic anti- coagulation was administered. She was transferred to the neurology department, and her condition improved. However, difficulty in walking still persisted at the time of discharge. Presence of anti-CMV-specific IgM antibodies combined with anti-CMV-specific IgG antibodies was revealed by serological tests performed on day 2 of hospitalisation. Low-avidity anti- CMV IgG antibodies were also detected. CMV primary infection at an early stage of pregnancy was diagnosed. PCR was negative in the CSF, but positive in the whole blood. The foetus had a high-risk of CMV infection due to mother- foetus transmission. Consequently, amniocentesis was planned at 21 weeks of amenorrhoea for virological analysis and monthly ultrasound (US) monitoring was initiated. Fluctuating values of whole blood CMV DNA load were observed from the virological monitoring. US monitoring at 21 weeks of amenorrhoea revealed placentomegaly with diffuse calcification, hyperechogenic bowel and retarded intrauterine growth of less than 3%. Oligohydramnios was noted and hence amniocentesis could not be performed. th Intrauterine foetal death was diagnosed in the 25 week of amenorrhoea and delivery was prompted. Amniotic fluid could not be collected. Chronic villitis was observed from the pathological findings of the placenta. Immuno-histochemical staining revealed CMV-positive placental cell nuclei. PCR for CMV was positive in the placenta with a high viral load. These findings were consistent with congenital CMV infection. Author comment: "We describe an unusual case of GBS after CMV primary infection in a pregnant woman." "[W]e do not know whether the initial moderate-dose corticosteroid therapy received before hospitalization could have interfered with the patient’s cellular immune response." ""[I]n utero fetal death caused by CMV congenital infection unfortunately occurred." Lupo J, et al. Guillain-Barre syndrome and cytomegalovirus infection during pregnancy. Journal of Clinical Virology 79: 74-76, Jun 2016. Available from: URL: https://doi.org/10.1016/j.jcv.2016.04.010 - France 803285546 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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