Massive Perivillous Fibrin Deposition in Congenital Cytomegalovirus Infection: A Case Report

Abstract

Cytomegalovirus (CMV) infection is one of the most common congenital viral infections. Classically associated placental findings include chronic villitis with plasma cells, stromal hemosiderin deposition, and identification of viral inclusions in villous endothelial and stromal cells. We present a case of confirmed congenital CMV infection that lacked these classical findings, but demonstrated massive perivillous fibrin deposition (MPVFD). This is the first report of CMV associated with MPVFD. MPVFD is an uncommon placental lesion associated with adverse fetal outcomes and a high risk of recurrence. However, the recurrence risk in patients with an infectious cause may be lower in than patients with other associated clinical conditions.

Fetal akinesia deformation sequence and massive perivillous fibrin deposition resulting in fetal death in six fetuses from one consanguineous couple, including literature review

“…Of these, 12 could not be included because no full text was available. After reading the full text of all of the remaining articles, 63 were included (Abdulghani et al, 2017 ; Achuthan et al, 2017 ; Adams‐Chapman et al, 2002 ; Al‐Adnani et al, 2008 ; Al‐Sahan et al, 2014 ; Ananthan et al, 2019 ; Andres et al, 1990 ; Bane & Gillan, 2003 ; Batcup et al, 1985 ; Bendon & Hommel, 1996 ; Benirschke et al, 2000 ; Brown et al, 2002 ; Chaiworapongsa et al, 2016 ; Chang et al, 2006 ; Chisholm et al, 2016 ; Clewell & Manchester, 1983 ; da Cunha Castro & Popek, 2007 ; Devisme et al, 2017 ; Eom et al, 2008 ; Faye‐Petersen et al, 2018 ; Feist et al, 2015 , 2019 , 2020 ; Gao et al, 2021 ; Gestrich et al, 2020 ; Gibbins et al, 2020 ; Griffin et al, 2012 ; Gupta et al, 2004 ; Hannaford et al, 2019 ; He et al, 2018 ; Heller et al, 2016 ; Hung et al, 2006 ; Jaiman et al, 2020 ; Katz et al, 1987 , 2002 ; Kim et al, 2019 ; Leavey et al, 2019 ; Leong et al, 2013 ; Linn et al, 2013 ; Makino et al, 2004 ; Maloney & Baergen, 2010 ; Man et al, 2016 ; Mandsager et al, 1994 ; Matern et al, 2001 ; Minamoto et al, 2019 ; Mongula et al,…”

“…Other congenital anomalies reported were renal anomalies in seven cases with contractures in four out of seven (Chang et al, 2006;Leong et al, 2013;Linn et al, 2013;Taweevisit & Thorner, 2010), three cases of mutation in LCHAD (Griffin et al, 2012;Matern et al, 2001) pulmonary valve dysplasia (Montenegro et al, 1997). The combination of MPFD with hypercoiling of the umbilical cord was reported in six cases (Feist et al, 2020;Gestrich et al, 2020;Taweevisit & Thorner, 2016). It is remarkable that borderline MPFD resulted in live born infants in the majority (84/89) and except for 1 trisomy 21, no other congenital or chromosomal anomalies were reported.…”

“…Other congenital anomalies reported were renal anomalies in seven cases with contractures in four out of seven (Chang et al, 2006 ; Leong et al, 2013 ; Linn et al, 2013 ; Taweevisit & Thorner, 2010 ), three cases of mutation in LCHAD (Griffin et al, 2012 ; Matern et al, 2001 ), one osteochondral junction lesions (da Cunha Castro & Popek, 2007 ), one aplasia of the left diaphragm, and one pulmonary valve dysplasia (Montenegro et al, 1997 ). The combination of MPFD with hypercoiling of the umbilical cord was reported in six cases (Feist et al, 2020 ; Gestrich et al, 2020 ; Taweevisit & Thorner, 2016 ).…”

Covid-19 during Pregnancy – Histopathological Lesions of the Placenta

“…Diffuse perivillous fibrin deposition is associated with deteriorated gas exchange causing fetal growth restriction, preterm delivery, miscarriage, and stillbirth [23]. Massive perivillous fibrin depositions have been associated with intrauterine infections caused by cytomegalovirus, Coxsackie A virus, and other enteroviruses through hematogenous maternal infection and activation of coagulation [23][24][25][26]. The literature described diffuse fibrin deposition in Covid-19 [20,27,28].…”

A Case Series on Pregnant Patients with Mild Covid-19 Infection and Signs of Severe Placental Insufficiency

“…Previous studies show that MPVFD has been associated with an increased risk of intrauterine growth restriction, preterm birth, and intrauterine fetal death (IUFD). MPVFD has also been described to correlate to maternal autoimmune disease and some viral infections [ 12 – 15 ].…”