A pregnant lady had no complaints but mild cervical lymphadenopathy in first trimester. She was prescribed spiramycin but she was noncompliant. Baby was born with hydrocephalus and intracerebral calcification. Which of these is likely cause ?

Hydrocephalus and intracerebral calcification can occur in all the four options either commonly (Toxoplasma, CIVIV) or uncommonly (HSV, rubella). See previous explanation. However, spiramycin in pregnancy is given for toxoplasmosis. Acute maternal toxoplasmosis is usually asymptomatic, some patients may present with posterior cervical lymphadenopathy, fatigue, lassitude and maculopapular rash. Spiramycin reduces the risk of congenital infection in acute toxoplasmosis during pregnancy. As the patient was not compliant with spiramycin, baby developed congenital toxoplasmosis.