Parvovirus B19 Intrauterine Infection and Eventration of the Diaphragm

Georgios Mitsiakos,Ilias Chatziioannidis,Christina Mitsiakou,Nikolaos Nikolaidis,Vasilios Mouravas,Vasilios Lampropoulos,Christoforos Gavras,Georgios N Katsaras

doi:10.14712/23362936.2022.6

Abstract

Parvovirus B19 infection in pregnancy may have a poor outcome for the fetus. Ocular anomalies, brain damage with hydrocephalus and central nervous system (CNS) scarring, cleft lip and hypospadias, as well myocarditis and congenital heart disease have been reported. We present a case of a preterm female neonate born with ascites, hydrothorax and congenital diaphragmatic eventration (CDE), with a prenatal diagnosis of congenital diaphragmatic hernia (CDH). The neonate was born prematurely at 32 weeks gestation with caesarean section due to a previous caesarean delivery. She was immediately intubated in the delivery room, transferred in the Neonatal Intensive Care Unit (NICU) and supported with high frequency oscillatory ventilation (HFOV). The diagnosis of CDH was sonographically estimated from the 20th week of gestation and surgical correction was decided. During surgery CDE was diagnosed instead of CDH and despite postoperatively care the neonate developed disseminated intravascular coagulation and finally died in the 40th hour of life. Along with the identification of parvovirus B19 in the pleural fluid by PCR, the biopsy of the diaphragm revealed connective tissue, full of vasculature and absence muscle tissue. Although only cytomegalovirus, rubella, and toxoplasmosis were considered to be associated with CDE, parvovirus B19 might also be related to this congenital diaphragmatic malformation. In CDE, the function of the lungs can be compromised as a consequence of the compression applied by the abdominal organs. The neonatologists should include this condition in their differential diagnosis for a more direct and effective management.

Highlights

Human parvovirus B19 was first identified by Cossart et al in 1975 in the serum of normal blood bank donors after being screened for the hepatitis B virus
Congenital diaphragmatic eventration (CDE) is generally defined as an abnormal displacement of a portion or whole of an attenuated but otherwise intact diaphragm into the thoracic cavity. It mimics the features of congenital diaphragmatic hernia (CDH) with displacement of abdominal organs into the thorax (Clifton and Wulkan, 2017)
Case report A female neonate was prematurely born after 32 weeks of gestation with caesarean section due to a previous caesarean delivery. She was immediately intubated in the delivery room and afterwards she transferred in the Neonatal Intensive Care Unit (NICU), where support with high frequency oscillatory ventilation (HFOV) was provided

Summary

Introduction

Human parvovirus B19 was first identified by Cossart et al in 1975 in the serum of normal blood bank donors after being screened for the hepatitis B virus. Congenital diaphragmatic eventration (CDE) is generally defined as an abnormal displacement of a portion or whole of an attenuated but otherwise intact diaphragm into the thoracic cavity. It mimics the features of congenital diaphragmatic hernia (CDH) with displacement of abdominal organs into the thorax (Clifton and Wulkan, 2017). Pleural fluid biochemical analysis was compatible with a transudate (Table 2), while PCR testing identified parvovirus B19 genome. Dramatic deterioration of the clinical condition due to a disseminated intravascular coagulation (DIC) developed post operatively and the neonate died within few Figure 1 – First chest X-ray: a bowel gas pattern in the right hemithorax and herniation of the liver. Because of that outcome we couldn’t further investigate for potential genetic syndromes with severe malformations

Discussion

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Conclusion