Successful management of parvovirus B19-associated maternal mirror syndrome: A case report and review of the literature

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OBJECTIVE: Maternal mirror syndrome (MMS), or Ballantyne syndrome, is a rare complication of pregnancy characterized by maternal symptoms that parallel fetal hydrops. Though originally associated with rhesus isoimmunization, MMS can result from diverse immune and non-immune conditions, including Parvovirus B19 (PVB19) infection. This report emphasizes the importance of early recognition and management of MMS secondary to PVB19 infection. CASE REPORT: A 38-year-old G2P1 patient at 27 + 2 weeks was diagnosed with severe fetal anemia and hydrops via ultrasound and underwent intrauterine blood transfusions (IBT). The patient subsequently developed MMS, showing significant anasarca, altered liver function, and an elevated sFLT/PLGF ratio. Treatment with albumin and furosemide effectively stabilized her condition. Delivery occurred via cesarean section at 32 weeks following preterm premature rupture of membranes, with the neonate requiring NICU admission and intensive care. CONCLUSION: Timely diagnosis and treatment of MMS due to PVB19 can significantly improve maternal and neonatal outcomes in complex cases.

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