Article Text

UNEXPLAINED SEVERE PERIVENTRICULAR LEUKOMALACIA IN AN OTHERWISE HEALTHY PREMATURE INFANT: ROLE OF MATERNAL MORGANELLA MORGANII CHORIOAMNIONITIS?
  1. R De Sousa1,
  2. M Ecoffey1,
  3. A Gervaix1
  1. 1Department of Pediatrics, HUG, Geneva, Switzerland

Abstract

Introduction Several risk factors have been linked to the development of periventricular leukomalacia, including chorioamnionitis. Morganella morganii is known as a rare pathogen for chorioamnionitis. We present a case where both neonate leukomalacia and maternal Morganella morganii chorioamnionitis occur, and question a possible causality.

Case report A 36-year-old healthy woman presented at 28 weeks with spontaneous onset of labour and a clinical suspicion of chorioamnionitis. Membranes were intact. Four hours later, a girl was delivered vaginally with good Apgar scores. The clinical evolution was uneventful and the infant did not present any clinical or biological signs of infection. Nevertheless, ultrasound studies on day one showed diffuse periventricular hyperechogenicity and cerebral MRI on day five showed a massive bilateral periventricular leukomalacia. Placental histology showed severe chorioamnionitis and cultures were positive for Morganella morganii.

Discussion Morganella morganii is a rare cause of early-onset systemic neonatal infection through maternal chorioamnionitis. Late-onset neonatal infections, rarely associated to meningitis or brain abscesses, have also been reported. The clinical presentation of the mother and child in this case is compatible with a subclinical infection causing preterm delivery and in utero brain injury. The association between chorioamnionitis, preterm delivery and periventricular leukomalacia is well established, but Morganella morganii has not yet been associated to this constellation.

Conclusion Morganella morganii is a rare cause of neonatal infection. The case reported showed a poor neurological outcome without any risk factor other than Morganella morganii maternal chorioamnionitis. This causality is debatable, but would represent the first case described.

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