Placental metastase like hypoechoic areas on ultrasonographic scan of a pregnant patient with reactivated infectious mononucleosis

One of the immunosuppressive conditions is pregnancy in which the maternal immune response is suppressed to prevent the rejection of the fetus, which can also permit reactivation of infectious mononucleosis. We present a case of infectious mononucleosis in a third trimester pregnancy in reactivation period presented with anhydramnios and hepatosplenomegaly. A 21 year old primigravid Turkish woman was attended to our antenatal clinic at 31 weeks of gestation with the symptoms of fatigue and myalgia at her back and arms. On ultrasonographic examination, it was noticed that placenta had an increased thickness with many round coin like hypoechoic areas on it. Physical examination of the patient revealed hepatosplenomegaly. Serologically reactivation of an Epstein-Barr virus infection was diagnosed. Twenty four hours after admission late decelerations appeared on nonstress test and the patient gave birth to a 1537 grams male fetus by emergent cesarian sectio. Patient was discharged from the hospital at the second day of the surgery. Pathological examination of plasenta revealed many necrotic areas. It must be kept in mind that as an immunosupressive condition pregnancy causes reactivation of latent Epstein-Barr virus infection. Although symptoms are nonspecific, it should be suspected in pregnant women and the fetus should be closely monitored throughout pregnancy.