Congenital Anomaly of Central Nervous System Associated with Antenatal Coinfection with Cytomegalovirus and Toxoplasma: Clinical Case

Abstract

Background . The development of central nervous system (CNS) malformations may occur due to antenatal infection. Specific pathomorphological changes in CNS structures require further study. Clinical Case Description . The autopsy morphological study of the brain of a child who had antenatal toxoplasma and cytomegalovirus infections and who died at the age of 2 years was performed. Thickening of the pia mater with cloudy surface due to edema and focal sclerosis, generalized thrombosis of superior sagittal sinus, sinus rectus and sinus transverses, absence of corpus callosum, major commissural fibers, opened third ventricle and vermis of cerebellum agenesia, as well as mixed forms of obstructive hydrocephalus were revealed. Diffuse gliosis with glial cysts in the periventricular zones were revealed at histological examination of the alba. Pseudocysts filled with toxoplasms were identified in the cysts’ wall. Signs of productive vasculitis were noted. Comparison of pathomorphological changes in the brain and internal organs with anamnestic data of the patient (toxoplasma and cytomegalovirus infection during recent pregnancy, brain abnormality of the fetus on the second ultrasound screening at 21–22 weeks of gestation) and the results of histological examination of placenta was carried out to prove the correlation of antenatal infection with the development of brain anomalies. Pathognomonic signs of cytomegalovirus infection and toxoplasmosis were revealed in the placenta: cytomegalic cells, vascular thrombosis, white infarcts, fibrinoid necrosis of basal lamina, placental hypoplasia. Toxoplasmic cysts were detected in chorionic villae stroma, parietal thophoblast, amnion, decidual tissue. Conclusion . Antenatal viral-parasitic infection may be the cause of brain anomalies of the fetus. However, the child had no specific signs of cytomegalovirus infection (such as cytomegalic cells — owl eye cells), even when the placenta had pathomorphological changes typical for this infection. It can be assumed that the development of brain anomaly in this child could be associated with toxoplasma infection.