Falsch-positives mütterliches Röteln-IgM bei intrauterinem Fruchttod durch Parvovirus B19?

Abstract

A 38-year-old secundiparous woman was referred at 29 weeks of gestation for fetal death with massive hydrops fetalis. At 19 weeks of gestation, the mother had experienced a rubella-like rash with positive rubella-lgM. Against the regulations, no rubella serology had been done previously. Although there is no clear clinical distinction between rubella and fifth disease and false positive rubella-lgM tests in connection with fifth disease have been described in the literature, neither sucrose gradient centrifugation of the serum for specificity control nor parvovirus B19-serology were carried out at 19 weeks of gestation. The serum was discarded, and three was no sonographic follow-up of the fetus. Parvovirus B19 was detected in the heart blood of the dead fetus by polymerase-chain-reaction (PCR). Streptococcus intermedius (milleri) in pure culture was found in placental and fetal pharyngeal swabs. The clinical course, fetal hydrops with positive B19 PCR, and positive maternal B19 IgM at 29 weeks of gestation point to fifth disease with false positive rubella IgM. Fetal death could probably have been prevented by more accurate diagnostic measures, storage of serum samples, sonographic follow-up and fetal transfusion.