RESUMO
We present a case of congenital complete atrioventricular block in a preterm microcephalic male with multiple additional congenital anomalies, including spinal and rib abnormalities. The heart was structurally normal, and maternal tests for autoimmune disorders were negative. The brain had an immature lissencephalic appearance, suggestive of an insult early in gestation. Genetic testing was normal, virtually excluding chromosomal disorders that are known to cause lissencephaly. Viral studies were suggestive of cytomegalovirus infection during early gestation, and we believe that the patient's clinical presentation was most likely the result of an early cytomegalovirus infection. The finding of complete atrioventricular block in a patient with presumed cytomegalovirus infection would represent a very rare complication. "Isolated" complete atrioventricular block in a fetus should be considered an incentive for an extensive work-up in search for a possible etiology, rather than accepted as a final diagnosis.
Assuntos
Anormalidades Múltiplas/virologia , Bloqueio Atrioventricular/virologia , Infecções por Citomegalovirus/complicações , Lisencefalia/virologia , Anormalidades Musculoesqueléticas/virologia , Anormalidades Múltiplas/diagnóstico , Adulto , Bloqueio Atrioventricular/congênito , Bloqueio Atrioventricular/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Eletrocardiografia , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Lisencefalia/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Anormalidades Musculoesqueléticas/diagnóstico , Cuidados Paliativos , GravidezRESUMO
Pregnancy causes anatomic and physiologic changes in the gastrointestinal tract. Pregnant women with intestinal disease such as Crohn disease or ulcerative colitis pose a management challenge in clinical diagnosis, radiologic evaluation, and treatment secondary to potential risk to the fetus. Heightened physician awareness on possible etiologies such as appendicitis, diverticulitis, and rarely colorectal cancer is required for rapid diagnosis and treatment to improve maternal/fetal outcome. A multidisciplinary approach to evaluation is a necessity because radiologic procedures and treatment medications commonly used in nonpregnant patients may have a potential harmful effect on the fetus. The authors review several gastrointestinal conditions encountered during pregnancy and address presentation, diagnosis, and treatment of each condition.