Department of Gynecology, Felix Guyon Hospital, 97400 Saint-Denis, Reunion’ Island, France.

Case report:

This is a 20-year-old patient, G1P0, with unknown obstetric risk factors and no relevant medical history.

The first scan was normal (nuchal translucency was 1 mm / 60 mm CRL). The triple test was not performed. The second scan was performed at 22 weeks. The patient had a fever and cervical adenopathy at 24 weeks. The maternal viral serology revealed old immunization of Rubella, CMV or Herpes, no Toxoplasmosis immunization.

At 32 weeks, a third scan was performed. Moderate cerebral bilateral ventriculomegaly was seen(13 mm) (Image 1). The ultrasound findings demonstrated Sylvian operculation, normal corpus callosus but three intra-parenchymal calcifications (Image 2-5). Toxoplasmosis seroconversion was detected. An amniocentesis was proposed, but refused by the patient. The treatment with Adiazine and Malocid was begun.

At 35 weeks, bilateral ventriculomegaly increased to 14 mm. Sylvian operculation was normal. Subarachnoid spaces were normal. Further examinations of the brain in coronal, sagital and transverse sections showed normal sulci and gyri. Brain calcifications were persistent. A fetal cerebral MRI was proposed, but also refused by the patient. The patient met a neuro-pediatrician and a neonatologist for counselling of unfavorable prognosis (Chorioretinis, infantile seizures, deafness…) and delivered at 38 weeks (3400g; Apgar X). Neonatal toxoplasmosis infection was confirmed (IgM=20 UI/ml, IgG=1400 UI/ml).

Image 1: Moderate ventriculomegaly

Image 2-4: Calcifications

Image 5: Normal corpus callosus