Baylor University Medical Center Proceedings October 2017 - 463

Fetal ventriculomegaly and herpes encephalitis following
primary maternal herpes simplex infection
Jenna K. Sloan, MD, Chase R. Cawyer, MD, and Nathan S. Drever, MD

Uteroplacental transmission of a primary herpes simplex virus (HSV) infection in pregnancy has been reported; however, HSV ventriculomegaly of the
neonate has not been well documented in utero. We present a case of a
19-year-old woman who developed a primary HSV outbreak at 17 weeks
of gestation and was treated with acyclovir. A congenital malformation scan
at 18 weeks of gestation demonstrated no fetal abnormalities; however,
an ultrasound at 33 weeks showed a new finding of ventriculomegaly.
Additionally, hydrocephalus was confirmed with magnetic resonance imaging. New-onset ventriculomegaly in the setting of primary HSV infection
in pregnancy should be considered as an in utero diagnostic indicator of
antenatal herpes simplex infection and herpes encephalitis.

teroplacental transmission of a primary herpes simplex
virus (HSV) during vaginal delivery is well documented,
and neonatal infection is well understood. Though rare,
uteroplacental transmission of HSV infection during
pregnancy has been reported to cause similar sequelae in the
neonate; however, HSV ventriculomegaly of the neonate has
not been well documented in utero.
CASE DESCRIPTION
A 19-year-old G3P1102 woman presented for prenatal care
at 17 weeks and 5 days of gestation. Her past medical history
was signiﬁcant for methamphetamine abuse, tobacco abuse,
and negative maternal Rhesus factor (1). Obstetric history included an uncomplicated spontaneous term vaginal delivery
and an additional preterm delivery at 35 weeks, secondary to
placental abruption with a positive urine drug screen for methamphetamine. The patient complained of painful lesions on
her vulva during the initial prenatal visit and was subsequently
diagnosed with a primary HSV infection. The patient was then
started on acyclovir (200 mg taken by mouth 5 times daily for
10 days). Viral cultures were obtained and found to be positive
for HSV-2. A subchorionic hemorrhage had been noted during
a routine anatomy scan at 17 weeks of gestation.
Prior to the HSV outbreak, the patient had a normally appearing and normally growing male fetus at 17 weeks and 5 days
and again upon follow-up at 25 weeks of gestation (Figure 1). A
repeat ultrasound around 33 weeks of gestation revealed severe
lateral ventricle dilation (Figure 2). She declined amniocentesis.
Proc (Bayl Univ Med Cent) 2017;30(4):463-464

Figure 1. Fetal ventricles at 25 weeks (0.38 cm, normal size).

The patient presented with contractions and signs of active
labor 2 days after the fetal abnormality was noted on the ultrasound, at 34 weeks and 1 day of gestation. As no herpetic lesions
were present on a bright light exam, the infant was delivered
vaginally at the request of the patient. Upon delivery, the infant
had no respiratory eﬀort and the Apgar score was 1 and 7 at 1
and 5 minutes, respectively. The infant was intubated and noted
to have multiple skin lesions, which also cultured positive for
HSV-2. Shortly after admission to the neonatal intensive care
unit, the infant began to have seizures. Ultrasound and magnetic
resonance imaging ﬁndings (Figure 3) of the neonate conﬁrmed
hydrocephalus with severe lateral ventricle dilation. The infant
died on the ﬁfth day of life within 6 hours of being withdrawn
from respiratory support. The placenta was culture positive for
HSV-2 and showed signs of acute chorioamnionitis.
DISCUSSION
As HSV infection becomes increasingly common in people
of reproductive age, the rate of neonatal HSV exposure is likely
From the Department of Obstetrics and Gynecology, Baylor Scott & White Health
and Texas A&M Health Science Center College of Medicine, Temple, Texas.
Corresponding author: Nathan S. Drever, MD, Scott & White Medical Center,
2401 South 31st Street, Temple, TX 76508 (e-mail: Nathan.Drever@BSWHealth.
org).
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