Intrauterine Acquired Congenital Herpes Simplex Virus Infection in a Newborn

Aim: We present a fatal case of congenital herpes simplex virus (HSV) infection following exposure of a non-immune mother by her partner during critical fetal development.Background: Globally, neonatal HSV infection affects 1 in 10,000 births.The most common mode of transmission is perinatally through passage through the vaginal canal (85%), followed by postnatal acquisition (10%).Rarely, intrauterine infection can occur (5%) resulting in congenital HSV, presenting with a classic triad of skin desquamation, chorioretinitis and brain malformations including hydrocephaly, anencephaly, and porencephaly.Case description: A 30-week pregnant woman with a history of flu-like illness at 18 weeks presented with decreased fetal movement and vaginal bleeding.Initial evaluation showed echogenic bowel on ultrasound.At 30 weeks, polyhydramnios and fetal brain abnormalities were noted.A c-section was performed, and the infant required resuscitation.The infant's father reported a history of genital HSV outbreaks and HSV-2 was detected in the infant's blood.The infant had extensive skin desquamation, seizures, and succumbed to fatal brain malformations.Conclusion: While maternal treatment with antiviral medication and cesarean section are effective in preventing perinatal HSV infection, congenital infection in the first or second trimester of pregnancy with devastating consequences for the fetus can occur in women without HSV immunity.Clinical significance: Given the lack of available HSV immunization, protection of non-immune pregnant individuals from HSV exposure is currently the only preventive measure against congenital HSV disease.