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Congenital diffuse necrotizing herpetic retinitis
1Department of Ophthalmology, University of Texas Medical Branch, Galveston 77550.
Summary
Neonatal herpes simplex virus infection can occur before birth. This case confirms in utero transmission causing severe brain and eye damage in a newborn.
Area of Science:
- Neonatal infections
- Virology
- Pathology
Background:
- Neonatal herpes simplex virus (HSV) infections are typically acquired during passage through the birth canal.
- Postnatal infections manifest with systemic lesions days to weeks after delivery.
Observation:
- A newborn with prenatal hydrocephalus diagnosis expired at 1 day of age.
- Clinicopathologic examination revealed severe liquefaction necrosis and calcification in the brain, adrenal glands, and retina.
- Cowdry type A intranuclear inclusions were identified in adrenal glands and retina.
Findings:
- This case documents the first instance of in utero transmission of HSV.
- Polymerase chain reaction confirmed HSV infection.
- The infection resulted in fulminant necrotizing retinitis and encephalitis.
Implications:
- In utero HSV transmission is a rare but devastating cause of neonatal mortality.
- Early diagnosis and intervention strategies for prenatal HSV exposure are critical.
- This case highlights the importance of considering congenital HSV infection in neonates with unexplained neurological and ocular abnormalities.