title: Cytomegalovirus-induced mirror syndrome associated with elevated levels of circulating antiangiogenic factors.
abstract: BACKGROUND
  We describe a case where Mirror syndrome was characterized by altered levels of antiangiogenic proteins (soluble fms-like tyrosine kinase 1 [sFlt1] and soluble endoglin).
  
  
  METHODS
  We describe a pregnant patient with severe fetal and placental edema induced by congenital cytomegalovirus (CMV) infection that was associated with preeclampsia. Fetal CMV was confirmed histologically, whereas antiangiogenic factors were demonstrated to be elevated in maternal but not fetal blood. The levels of sFlt1 and soluble endoglin in our patient's serum before delivery were 116.5 ng/mL (normal pregnancy 19.3 ng/mL and preeclampsia 66.0 ng/mL, representing mean values before delivery) and 107.4 ng/mL (normal pregnancy 18.7 ng/mL and preeclampsia 52.6 ng/mL, representing mean values before delivery), respectively. In contrast, the values of sFlt1 and soluble endoglin in the cord blood were relatively low at 2.1 ng/mL and 8.2 ng/mL, respectively.
  
  
  CONCLUSIONS
  If this observation is confirmed, CMV infection may be cited as a cause of Mirror syndrome and preeclampsia phenotypes associated with this disorder may be related to increased circulating antiangiogenic factors.
authors.affiliation: Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, Rhode Island 02905, USA. saroshrana@gmail.com
authors.forename: Sarosh
authors.initials: S
authors.lastname: Rana
authors.forename: Shivalingappa
authors.initials: S
authors.lastname: Venkatesha
authors.forename: Monique
authors.initials: M
authors.lastname: DePaepe
authors.forename: Edward K
authors.initials: EK
authors.lastname: Chien
authors.forename: Michael
authors.initials: M
authors.lastname: Paglia
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
mesh_terms: D000328:Adult; D042501:Angiogenic Proteins / Q000097:blood*; D002585:Cesarean Section; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications / Q000151:congenital / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005315:Fetal Diseases / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D013577:Syndrome
chemical_list: D042501:Angiogenic Proteins