Elevated maternal serum and amniotic fluid alpha-fetoprotein associated with in utero cytomegalovirus infection

Objective: We report a unique case of congenital cytomegalovirus infection characterized by both elevated maternal serum and amniotic fluid α-fetoprotein (MSAFP and AFAFP). Methods/Results: Amniotic fluid culture and fetal blood analysis diagnosed cytomegalovirus infection in a hydropic and growth-impaired 22-week fetus. The MSAFP was 4.37 MOM, and the AFAFP was 6.72 MOM. AF acetylcholinesterase and fetal hemoglobin were absent. No congenital anomalies were present. A neonatal urine culture positive for cytomegalovirus confirmed the prenatal diagnosis. Conclusion: In utero cytomegalovirus infection should be considered in the differential diagnosis of elevated MSAFP, especially if the AFAFP is also inexplicably elevated. MSAFP and AFAFP levels may be reasonable to study for determining the prognosis for cases of in utero cytomegalovirus infection.