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Pseudo-meconium ileus due to cytomegalovirus infection: a report of three cases
P J Déchelotte1, N M Mulliez, R J Bouvier
1Laboratory of Pathology (Fetopathology Unit), Hôtel Dieu, Clermont Ferrand, France.
Abstract:
We observed three cases of antenatal ileus associated with cytomegalovirus (CMV) infection of the fetus and placenta. Two were detected antenatally because of increased echogenicity of the lower abdomen. In the first fetus, the ileus was associated with abnormalities of amniotic fluid enzymes but it was transient and not present at autopsy and the CMV infection was mild, without inflammatory infiltration or necrosis. In the two others, the ileus persisted and CMV-associated lesions were severe. In all three cases the virus was demonstrable in ganglion cells or within myenteric and submucosal plexuses all along the small and large intestine; ileus was imputed to CMV, which caused a paralytic ileus, and in one fetus meconium ileus was also present. A transient episode of ileus does not indicate that the fetus is free of disease and a wide range of causes must be considered, including CMV infection as well as the more usual causes such as cystic fibrosis (CF) and Hirschsprung's disease.
Insights
Cytomegalovirus (CMV) infection can cause fetal antenatal ileus, a blockage in the fetal intestine. This condition requires careful consideration alongside other potential causes like cystic fibrosis.
Area of Science:
- Perinatology
- Virology
- Gastroenterology
Background:
- Antenatal ileus, a fetal intestinal obstruction, presents diagnostic challenges.
- Cytomegalovirus (CMV) is a common congenital infection with diverse fetal effects.
Observation:
- Three cases of fetal antenatal ileus linked to maternal-fetal CMV infection were identified.
- Two cases were detected prenatally due to increased fetal abdominal echogenicity.
- CMV was consistently found within the intestinal nerve plexuses in all cases.
Findings:
- Ileus severity correlated with CMV-associated placental and fetal lesions.
- CMV infection was implicated as the cause of paralytic ileus.
- One fetus also presented with meconium ileus.
Implications:
- Transient antenatal ileus does not exclude significant fetal disease.
- CMV infection should be considered in the differential diagnosis of antenatal ileus.
- Distinguishing CMV-induced ileus from other causes like cystic fibrosis and Hirschsprung's disease is crucial.