Prenatal diagnosis and in utero treatment of severe congenital toxoplasmosis: a case report

Abstract

Abstract Background Acute infection of pregnant women with Toxoplasma gondii can result in fetal transmission. When clinical abnormalities are evident by ultrasonography in late gestation, medical treatment may be attempted, but the data on outcomes are limited. Objectives To present a case of congenital fetal toxoplasmosis from Thailand and review the literature. Methods A woman presented at 31 weeks of gestation with severe bilateral ventriculomegaly, cardiomegaly, hepatosplenomegaly with intrahepatic hyperechogenicities, and polyhydramnios. Medical treatment with pyrimethamine, sulfadiazine and folinic acid was initiated. There was no improvement. Social, medical, ethical and legal issues were considered. Results Delivery was indicated at 34+2 weeks of gestation because of premature amniorrhexis. The neonate suffered from respiratory distress, meningitis, ventilator-associated pneumonia, and expired at age 11 days. Conclusions When fetal congenital toxoplasmosis is diagnosed late in pregnancy with severe ultrasonographic abnormalities, the neonatal outcome is poor despite in utero treatment with antibiotics.