PC2157: A Newborn with Adenomyomatosis of the Gallbladder in a Mother with SARS cov-2 Infection During Pregnancy

Introduction: Adenomyomatosis of the gallbladder is an acquired condition of mucosal hypertrophy leading to invaginations and diverticula penetrating a thickened muscularis. Adenomyomatosis can be identified sonographically by the presence of Rokitansky-Aschoff sinuses with a comet tail artifact from reverberation between sinuses. It is typically diagnosed in patients after age 50, but it has also rarely been described in the neonatal period. We present a case of a one-day-old with abnormal findings on perinatal ultrasound born to a mother who had SARS CoV-2 infection during pregnancy.

Case Description: A one-day-old male infant was born via uncomplicated spontaneous vaginal delivery to a 39-year-old primagravada mother at 40+1 weeks estimated gestational age (EGA). The initial fetal ultrasound was completed at 20+1 weeks EGA and was unremarkable. Prenatal history was notable for mildly symptomatic maternal SARS Cov-2 infection despite full vaccination diagnosed by PCR testing around 31 weeks EGA. Subsequent fetal ultrasound at 35+5 weeks EGA identified gallbladder wall calcifications with otherwise normal findings. Non-invasive perinatal testing showed no evidence of aneuploidy. Mother was rubella immune and HIV, Hepatitis B, Hepatitis C, and treponema negative. After delivery, the infant was well appearing, appropriate size for gestational age, and without evidence of hepatosplenomegaly on exam. He was breastfeeding and passed meconium in the first 24 hours. An abdominal ultrasound showed multiple intramural echogenic foci with a posterior echogenic comet tail artifact consistent with gallbladder adenomyomatosis (image). Transcutaneous bilirubin measured 3.7 mg/dL at 24 hours of life. He never developed clinically significant jaundice. He showed excellent growth at his two week follow-up visit with a normal transition of stools. The infant’s newborn screen was normal. On follow-up ultrasound at 4 weeks of age, the gallbladder and liver were normal in appearance. No subsequent testing was recommended.

Discussion: Adenomyomatosis of the gallbladder is a benign finding in adults with only a few reported cases in infants. The exact pathogenesis remains uncertain. In the small number of infant case reports, serial ultrasounds demonstrate resolution around three to eight months of age. SARS CoV-2 has been associated with various patterns of hepatobiliary involvement. While there have been few documented cases of likely vertical transmission of SARS-CoV-2, there has been at least one other case report of fetal gallbladder calcification in the setting of maternal SARS CoV-2 infection. It should be noted that, while SARS CoV-2 serology was not obtained in our infant, the timing of the perinatal ultrasound changes coincide with the mother’s infection.

Conclusion: This case adds to a small body of literature regarding infantile adenomyomatosis while also highlighting a potential role for maternal infectious etiology.