Prenatal diagnosis of an exceptional intrauterine herpes simplex type 1 infection

Abstract

To assess ultrasound findings of a fetus with intrauterine growth retardation (IUGR) and skin damage, related to intrauterine herpes simplex virus (HSV) infection. A 23-year-old, G1, P0 woman was referred at 23.5 weeks' gestation (WG) for IUGR. The patient had a previous single episode of serotype 1 herpes progenitalis at 11 WG. Ultrasound examination revealed extensive skin changes with no cerebral involvement. The methods employed for evaluation of the disease included maternal serology, amniocentesis and repeated ultrasound examinations. Maternal serology was positive for HSV1 and fetal infection was confirmed via polymerase chain reaction (PCR). At 27 WG, amniotic fluid index decreased and lower limb skin as well as abdominal skin was irregular. Oesophagus was thickened. In contrast, upper limb skin and cranial vault were thin and less visible. IUGR was predominant as regards bone parameters. After termination of pregnancy, the fetus showed macroscopic characteristics of HSV infection. Microscopic examination revealed only placental and skin lesions. Our report illustrates a rare case of HSV1 intrauterine infection that occurred during the first trimester with bone and cephalic IUGR associated with extensive skin damage, and with no cerebral involvement.