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Z Geburtshilfe Neonatol 2013; 217(05): 183-188
DOI: 10.1055/s-0033-1355349
Case Report
© Georg Thieme Verlag KG Stuttgart · New York

Ballantyne Syndrome and Congenital Anaemia Associated with Parvovirus B19 Infection: Case Report and Review

Ballantyne Syndrom und konnatale Anämie durch Parvovirus B19: Kasuistik und Literaturübersicht
M. Schoberer
1   Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Universitätsklinikum Aachen, Aachen, Germany
,
A. Rink
2   Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen, Aachen, Germany
,
W. Rath
2   Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Aachen, Aachen, Germany
,
T. Orlikowsky
1   Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Universitätsklinikum Aachen, Aachen, Germany
› Author Affiliations
Further Information

Publication History

received17 April 2012

accepted after revision04 October 2012

Publication Date:
29 October 2013 (online)

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Abstract

Acute maternal Parvovirus B19 infection affects about 1% of all pregnancies worldwide. Diaplacental transmission of Parvovirus B19 during the second trimester can cause complications like foetal hydrops, premature delivery or foetal loss in about 20–30% of these pregnancies, whereas the majority of maternal infections remain clinically silent. In individual cases, foetoplacental hydrops (of various origins) can trigger a rare form of Preeclampsia in the pregnant woman. The developing maternal oedema in this situation apparently “mirrors” the hydropic state of the foetus. The symptom triad of foetal hydrops, foetoplacental oedema and maternal anasarca defines Ballantyne syndrome. We report a case of Parvovirus-induced Ballantyne syndrome including a 10-year follow-up of mother and child. While the mother recovered rapidly after (preterm) delivery, the infection complicated the first months of life of the neonate. Congenital transfusion-dependent red cell aplasia and cholestatic hepathopathy took a chronic course but resolved under IVIG treatment. Follow-up now finds both the former neonate and the mother entirely recovered. Current knowledge on Ballantyne syndrome as well as perigestational Parvovirus infections including congenital anaemia is briefly reported and pathophysiological hypotheses are discussed.

Zusammenfassung

Akute Infektionen mit Parvovirus B19 betreffen weltweit etwa 1% der Schwangerschaften. Eine diaplazentare Übertragung des Erregers im zweiten Trimenon führt in rund 20–30% der Fälle zu Komplikationen wie Hydrops Fetalis, Frühgeburtlichkeit oder Spätabort, wohingegen die Mehrzahl der maternalen Infektionen klinisch stumm verläuft. ­In Einzelfällen kann ein fetoplazentarer Hydrops (egal welchen Ursprungs) bei der Schwangeren ­eine seltene Form der Präeklampsie auslösen. Maternale Anasarka „spiegeln“ in dieser Situation den Hydrops des Feten. Diese Symptomentrias fetaler Hydrops, Plazentaödem und maternale ­Anasarka definiert das Ballantyne Syndrom. Wir berichten die Kasuistik eines durch Parvovirus induzierten Ballantyne Syndroms einschließlich einer 10-jährigen Nachbeobachtung von Mutter und Kind. Während sich die Mutter nach der ­(vorzeitigen) Entbindung rasch erholte, verlief die Infektion bei dem Frühgeborenen langwierig und kompliziert: Sowohl eine kongenitale, transfusionspflichtige aplastische Anämie als auch eine cholestatische Hepatopathie nahmen einen chronischen Verlauf und bildeten sich erst nach rund einem Jahr unter intravenöser Immunglobulintherapie zurück. In der Nachbeobachtung ist die Erkrankung bei Mutter und Kind folgenlos ausgeheilt. Der Artikel gibt eine Übersicht über den aktuellen Stand des Wissens bezüglich des Ballantyne Syndroms und gestationsassoziierter Parvovirus Infektionen. Pathophysiologische Zusammenhänge und Hypothesen werden diskutiert.

Key words

Ballantyne syndrome - triple edema - mirror syndrome - preeclampsia - fetal hydrops - Parvovirus - congenital anaemia

Schlüsselwörter

Ballantyne Syndrom - Triple-Ödem - Mirror-Syndrom - Präeklampsie - Hydrops fetalis - Parvovirus - kongenitale Anämie
 

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