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Pediatr Dev Pathol. 2019 Mar-Apr;22(2):142-145. doi: 10.1177/1093526618798772. Epub 2018 Sep 7.

Massive Perivillous Fibrin Deposition of an Enterovirus A-Infected Placenta Associated With Stillbirth: A Case Report.

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1 Department of Pathology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany.
2 Department of Pathology, Center for Perinatal and Pregnancy-Related Pathology, Oslo University Hospital-Ullevål, Oslo, Norway.
3 Department of Pathology, Hannover Medical School, Hannover, Germany.
4 Department of Obstetrics and Gynecology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany.
5 Department of Virology, Hannover Medical School, Hannover, Germany.


Massive perivillous fibrin deposition (MFD) is a morphologically defined severe placental lesion associated with perinatal morbidity and mortality. The etiology is unknown, and recurrence risk in subsequent pregnancies is assumed to be high. In most cases, a pathologic immune reaction is supposed to be responsible for the lesion. We report a case of a pregnant woman's suffering from hand, foot, and mouth disease in the 20th gestational week. Subsequently, MFD developed in the placenta and was followed by intrauterine growth restriction and stillbirth in the 29th gestational week. Enterovirus A with high homology to Coxsackievirus A16 was detected in the placenta by means of immunohistochemisty and reverse transcription polymerase chain reaction. This infection could be a rare cause of MFD and should be taken into consideration in the differential diagnosis of the individual etiology. Recurrence risk of virus-related MFD is expected to be lower than in MFD without infectious association.


Coxsackievirus; massive perivillous fibrin deposition; placental pathology; stillbirth

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