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A Report of Three Cases and Review of Intrauterine Herpes Simplex Virus Infection

Marquez, Lucila MD*; Levy, Moise L. MD*†‡§; Munoz, Flor M. MD; Palazzi, Debra L. MD*

The Pediatric Infectious Disease Journal: February 2011 - Volume 30 - Issue 2 - p 153-157
doi: 10.1097/INF.0b013e3181f55a5c
Instructive Case

Background: Intrauterine herpes simplex virus (HSV) infection often is omitted from descriptions of neonatal HSV disease. Previous characterizations of intrauterine HSV infection limit manifestations to the triad of cutaneous, central nervous system (CNS), and ophthalmologic findings. We report 3 cases of intrauterine HSV infection and provide a contemporary literature review of this disease.

Methods: Cases published between 1963 and January 2009 were identified. Selected cases fit the clinical description of intrauterine HSV infection, had manifestations present at birth, and had virologic confirmation of infection.

Results: This review yielded 64 cases, 3 of which were our own, of intrauterine HSV infection. Less than one-third fit the typical triad. Of the patients with cutaneous findings at birth, 24 (44%) had manifestations other than vesicles or bullae. Confirmation of HSV infection by culture of cutaneous lesions present at birth was delayed beyond 72 hours after birth in 15 patients and occurred at a median of 10 days of age. Nine of these patients had lesions at birth that were neither vesicles nor bullae, and 14 cases were confirmed by culture of new vesicles.

Conclusions: More than two-thirds of reported cases do not present with the typical triad. Cutaneous findings are not limited to vesicles or bullae. A high index of suspicion and recognition of varied cutaneous manifestations is necessary to diagnose infants with intrauterine HSV infection.


From the *Department of Pediatrics, Infectious Diseases Section, and the †Department of Dermatology, Baylor College of Medicine, Houston, TX; ‡Department of Pediatric and Adolescent Dermatology, Specially for Children, Austin, TX; §Department of Pediatric Dermatology, Dell Children's Medical Center, Austin, TX; and ¶Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX.

Accepted for publication August 3, 2010.

Presented in part at the Pediatric Academic Societies' Annual Meeting, May 2–6, 2008, Honolulu, Hawaii.

Address for correspondence: Lucila Marquez, MD, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Avenue, Suite 1120, Houston, TX, 77030. E-mail:

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© 2011 Lippincott Williams & Wilkins, Inc.