Placental lesions induced by Omicron SARS-CoV-2 in a pregnant woman treated with anti-CD20

Abstract

Since the emergence of SARS-CoV-2 in 2020, specific placental lesions characterized by a triad of trophoblastic necrosis, chronic histiocytic intervillitis, and massive perivillous fibrin deposits have been documented during pregnancy. After the arrival of the Omicron variant in late 2021, no placental lesions were observed at our institution until a recent case in September 2024 involving an immunosuppressed patient treated with anti-CD20. In this case, pathological analysis revealed the classic lesion triad, with strong immunohistochemical positivity for SARS-CoV-2. This suggests that placental tropism persists in certain variants several years after the emergence of SARS-CoV-2, necessitating vigilance in monitoring potential complications, especially in immunocompromised patients, regardless of variant classification.

Keywords: Anti-CD20; COVID-19; Chronic histiocytic intervillitis; Histology; Massive perivillous fibrin deposits; Omicron; Placenta; Pregnancy; SARS-CoV-2; Trophoblastic necrosis.