Fetal stroke and congenital parvovirus B19 infection complicated by activated protein C resistance.
Parvovirus B19 infection in gestation has been associated with severe fetal complications such as anaemia, hydrops and fetal demise. Fetal infection in the first trimester poses the greatest risk for these complications, but infection during the third trimester is more common than previously appreciated and can be associated with severe complications, i.e. fetal death, in the absence of hydrops or classical clinical symptoms. Parvovirus B19 infection has been associated with vasculitis and pathological changes in the central nervous system, which may cause stroke. We report a newborn infant with a rare combination of a recent central nervous system infection with parvovirus B19 and a factor V Leiden mutation, who developed fetal stroke.


CONCLUSIONS
Factor V Leiden mutation leads to activated protein C resistance and increases the risk of thromboembolism. Thromboembolism occurs rarely in newborns with activated protein C resistance, but can be precipitated by dehydration, asphyxia and infection. Although parvovirus B19 infection of the central nervous system may be a precipitant in neonatal and/or fetal stroke, it can also cause stroke independent of a thrombophilic mutation. In this case, both causative factors may have coincided.
De Haan
Timo R
TR
Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands.
Van Wezel-Meijler
Gerda
G
Beersma
Matthias F C
MF
Von Lindern
Jeanette S
JS
Van Duinen
Sjoerd G
SG
Walther
Frans J
FJ
D020016:Activated Protein C Resistance / Q000150:complications / Q000151:congenital*; D000328:Adult; D001034:Apgar Score; D001344:Autopsy; D001921:Brain / Q000473:pathology; D016731:Erythema Infectiosum / Q000150:complications / Q000151:congenital*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016732:Parvovirus B19, Human; D011247:Pregnancy; D020521:Stroke / Q000000981:diagnostic imaging* / Q000196:embryology*; D016216:Ultrasonography, Prenatal; D019562:Viral Load