Hyperimmunoglobulin therapy for a twin fetus with cytomegalovirus infection and growth restriction

OBJECTIVE: Cytomegalovirus immunoglobulin was administered to a pregnant wo man with primary cytomegalovirus infection and placental involvement of I t win fetus, in whom growth restriction had developed. STUDY DESIGN: Inhibition of viral activity was attempted by administration of high-titer cytomegalovirus neutralizing antibodies for therapy of the in volved fetoplacental unit and prevention of cytomegalovirus infection in th e uninfected twin fetus. RESULTS: After cytomegalovirus immunoglobulin infusions the placental edema decreased and the infected fetus started to grow once again, showing at bi rth only hepatosplenomegaly associated with viruria and cytomegalovirus deo xyribonucleic acidemia. Moreover, cytomegalovirus immunoglobulin G avidity increased and cell-mediated immunity improved. The other twin, who had nega tive results of cytomegalovirus culture and deoxyribonucleic acid detection at birth, was found to have cytomegalovirus deoxyribonucleic acid in the u rine after 1 week. From the age of 9 months, however, both twins had persis tent negative results of cytomegalovirus deoxyribonucleic acid detection. CONCLUSION: Although large-scale studies are needed to establish the real e fficacy and the best therapeutic regimen, cytomegalovirus immunoglobulin ma y be considered for treatment or prevention of fetal cytomegalovirus infect ion. (Am J Obstet Gynecol 1999;180:1222-6.).