No Footprint Too Small: Case Report of Intrauterine-acquired Congenital HSV Infection

By: Kaitlyn Lopushinsky & Nhung Ho

Introduction: Congenital infection due to intrauterine exposure to herpes simplex virus (HSV) is exceedingly rare, but when found is often associated with life-threatening complications and a significant mortality rate.

Objectives: 1. To describe the case of a preterm infant with intrauterine-acquired HSV infection 2. To discuss the epidemiology, features and complications associated with intrauterine-acquired HSV infection by conducting a review of medical literature.

Methods: The case of a preterm male infant who was born with diffuse erosions suggestive of intrauterine-acquired HSV infection is described. A concise literature review is discussed regarding the epidemiology, associated features, and complications of intrauterine-acquired HSV infection.

Case Description: A preterm male infant was born with diffuse erosions in various stages of healing suggestive of denuded bullae. The mother had a few atypical vesicles on one hand a few weeks prior to delivery, and was not treated. Prenatal ultrasound showed fetal cerebral ventriculomegaly, suspected Dandy-Walker malformation, and oligohydramnios. Neonatal skin swabs were positive for HSV-2 by polymerase chain reaction (PCR) and the patient was treated with intravenous acyclovir. MRI findings showed severe progressive ex-vacuo ventricular dilatation consistent with congenital herpes simplex infection. Due to those findings and comorbid cardiac pathology with worsening function, care was redirected to a palliative path and the child expired at 21 days of age.

Discussion: Although confirmed congenital HSV infections are very rare, the potentially devastating prognosis and complications as evidenced by our case show that awareness of congenital HSV is critical for pediatricians as well as physicians involved in antenatal care period in order to provide optimal care.

Conclusion: In order to adequately counsel pregnant women, more work must be done to elucidate the prevalence of intrauterine HSV leading to congenital infection as well as diagnostic means and potential antenatal treatment.

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