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Discordant Outcomes in a Case of Parvovirus B19 Transmission Into Both Dichorionic Twins

Published online by Cambridge University Press:  21 February 2012

Monika Schiesser
Affiliation:
Klinikum Traunstein, Germany; Department of Obstetrics and Gynaecology, University Women's Hospital, University of Heidelberg, Germany.
Consolato Sergi
Affiliation:
Institute of Pathology, Medical University of Innsbruck, Austria.
Martin Enders
Affiliation:
Labor Prof. Enders und Partner, Institut für Virologie, Infektiologie und Epidemiologie e.V., Stuttgart, Germany.
Holger Maul
Affiliation:
Department of Obstetrics and Gynaecology, University Women's Hospital, University of Heidelberg, Germany.
Paul Schnitzler*
Affiliation:
Dept. of Virology, University of Heidelberg, Germany. [email protected]
*
*Address for correspondence: Paul Schnitzler, Department of Virology, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.

Abstract

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Maternal infection with parvovirus B19 during pregnancy can cause aplastic anemia in the fetus and may lead to nonimmune fetal hydrops and fetal demise. Twin pregnancies complicated by infection due to parvovirus B19 are very rare clinical events. We present a dichorionic, diamniotic, dizygotic twin pregnancy after in vitro fertilization with parvovirus B19 infection and viral transmission to both twins, but different outcomes. At 19 weeks gestation, hydrops fetalis was diagnosed for male twin A, female twin B did not show any abnormalities. At 22 weeks gestation an acute parvovirus B19 infection was detected and twin A was diagnosed with intrauterine fetal death (IUFD) by ultrasound at 23 weeks gestation. Viral DNA was detected in maternal blood as well as in placenta and liver tissue of this twin. Twin B was born at 35 weeks gestation asymptomatically and no signs of hydrops or other congenital anomalies but viral DNA was detected by PCR in serum. At the age of 2 years, both IgG titres against B19 and parvovirus DNA amplification copies were still positive in plasma of the surviving twin, but no clinical signs were detectable. It is remarkable that both twins were infected with parvovirus B19 early in pregnancy but showed a discordant clinical outcome. Our case report describes the rare occurrence of an intrauterine fetal death (IUFD) of one twin and the asymptomatic infection of the other in a twin pregnancy.

Type
Articles
Copyright
Copyright © Cambridge University Press 2009