Zhong Zhen Goh¹, Jordan Wiebe¹, Seethalakshmi Viswanathan^1,2

¹Tissue Pathology & Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia

²University of Sydney, NSW, Australia

 

Toxoplasma gondii represents one of the ‘TORCH’ infections in pregnant women, and is known to cause spontaneous abortion, preterm labour, and significant infection in surviving newborns.¹ The risk of Toxoplasma infection is 0.1%-1% of all pregnancies.² We present a case of Toxoplasmosis villitis of the placenta. 

 

A 35 year-old female, G3P1M1, presented at 17 weeks of gestation, with vaginal bleeding. She subsequently had foetal death in-utero, diagnosed on ultrasound. Histopathological examination of the placenta showed diffuselymphohistiocytic, granulomatous and necrotising inflammation involving the placental membranes and chorionic villi. Toxoplasma pseudocysts were identified in the chorionic plate, which confirmed the diagnosis. Serological testing confirmed a positive Toxoplasma IgM and IgG. Given the patient showed evidence of mounting avidity to toxoplasmosis, the patient was not treated for Toxoplasmosis infection, but advised to wait another 12 months to conceive. 

 

Chronic villitis in early pregnancy should prompt for athorough examination for an infectious cause. In the case of Toxoplasma infection, pseudocysts and true cysts are commonly observed in chorionic plate and extraplacental membranes.³ The differential diagnosis is villitis of unknown aetiology, which has a high probability for recurrence in future pregnancies and necessitates further investigations.

 

1. Robbins JR, Zeldovich VB, Poukchanski A, Boothroyd JC, Bakardjiev AI. Tissue barriers of the human placenta to infection with Toxoplasma gondii. Infect Immun. 2012 Jan;80(1):418-28. doi: 10.1128/IAI.05899-11. Epub 2011 Nov 14. PMID: 22083708; PMCID: PMC3255695.

2. Nayeri T, Sarvi S, Moosazadeh M, Amouei A, Hosseininejad Z, Daryani A. The global seroprevalence of anti-Toxoplasma gondii antibodies in women who had spontaneous abortion: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2020 Mar 13;14(3):e0008103. doi: 10.1371/journal.pntd.0008103. PMID: 32168351; PMCID: PMC7069604.

3. Heerema-McKenney, A. (2018). Defense and infection of the human placenta. APMIS: acta pathologica, microbiologica, et immunologica Scandinavica, [online] 126(7), pp.578–579. doi:https://doi.org/10.1111/apm.12847.

I affirm that the writing above are of my original work.