MEDizzy - A 33-year-old woman, G3, P2, had two previous pregnancies

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Central Nervous System (II)

A 33-year-old woman, G3, P2, had two previous pregnancies that resulted in normal-term infants, but now she gives birth at 34 weeks’ gestation to a stillborn fetus. On examination, the fetus is observed to be hydropic. Autopsy of the fetus shows marked organomegaly, and the brain has extensive necrosis in a periventricular pattern, with focal calcifications. What congenital infection is most likely to produce these findings?

ExplanationCytomegalovirus (CMV) infection is one of the congenital TORCH infections, and it can become widely disseminated to affect the CNS. Periventricular leukomalacia is characteristic of CMV infection. Group B Streptococcus infections cause premature rupture of membranes and sepsis without significant CNS findings. Heart failure in utero causes hydrops fetalis. Herpes simplex virus infection of neonates typically occurs during passage through the infected birth canal, not in utero. HIV infection produces no significant CNS findings in the perinatal period.