Human parvovirus B19 associated non-immune hydrops fetalis

F Ovali, N Samanci, O Ozdemir, T Dagoglu
Non-immune hydrops fetalis (NIHF) in a relatively rare syndrome associated with different etiologies, usually due to chromosomal aberrations or cardiac anomalies. Human parvovirus B 19 (HPV B 19) associated intrauterine infections. NIHF and fetal loss have been reported lately 1 . HPV B19 passes through the placenta and infects eiythroid progenitor cells with subsequent lysis, anemia and hydrops. Fetal liver cells may be infected at the same time. The rate of HPV B 19 infection in NIHF cases is
more » ... unknown but estimated to be about 10% 2 . In anautopsy series, HPV B19 was found in 0.7% of all cases and in 16% of hydropic cases 3 . We present a non-irnmune hydrops case, which was due to HPV B 19 infection and discuss the recent issues governing this disease. Case Report O.B. was born as a second child of his family, after a gestation of 35 weeks. The mother had her first antenatal ultrasound examination at the 28th week and the baby was hydropic at that time. Cordocentesis revealed hemoglobin concentration of 8.8 g/dl, leucocyte count of 10.000/mm 3 , platelet count of 124 .000/mm 3 and a negative indirect coombs test. The liverenzymes (AST, ALT) were within normal limits. Close observation and monitoring was planned. The karyotype analysis revealed 46 XY Toxoplasma, rubella, cytomegalovirus and herpes virus antibodies were negative. Therefore, the baby was evaluated as non-immune hydrops fetalis. On admission to the neonatal intensive care unit, the physical examination of the baby revealed a weight of 3500 g (>90th centile), length of 47cm (50thcentile). head circumference of 36 cm (50th centile) and abdominal circumference of 36cm (>9Othcentile). He had mild tachypnea and dyspnea and normal breath sounds. The abdomen was flat with a frog-like appearance and liver was 2 cm palpable below the right costal margin. The examination of cardiovascular and other systems were unremarkable. Laboratory investigations were: Hematocnt: 60%, Hemoglobin 18.5 g/dl. White blood cells: 10.600/mm 3 , platelets: 175.000/mm 3 , reticulocytes: 1.2%, indirect coombs test negative, serum albumin 4.4 g/dl, AST: 78 UIL and ALT: 20 U/L. Anteroposterior chest x-ray and the echocardiogram were nonnal. Abdominal ultrasound revealed moderate ascites and grade II renal stasis, which was thought to be due to the ascites. Repeat toxoplasma, rubella, cytomegalovirus and herpes virus antibodies were negative but antiparvovirus B19 IgM and IgO were positive. Non-immune hydrops of the baby was thought to be secondary to HPV B 19 infection, No intervention but close monitoring of the baby was planned. On his first foflow-upvisitat 1 month, he was doing well and there was a slight increase (0.5 cm) in the abdominal circumference. By ultrasonographic examination, there was mild ascites. At second month, the abdominal circumference had increased to 38.6 cm with a hepatornegaly of 7 cm. and splenomegaly of 8 cm below the respective costal margins. Renal function was normal, total serum protein was 5.8 g/dl, albumin 3.
pmid:8991362 fatcat:n5gvlkib5rafncowplzx7ao3j4