A Rare Case of Limb Body Wall Complex Associated with Environmental Mercury Exposure and Maternal Herpes Infection
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Limb body wall complex (LBWC) is a rare and fatal congenital anomaly involving severe defects of the body wall, spine, limbs, and umbilical cord. This study aims to report a rare case of LBWC associated with environmental mercury exposure and maternal herpes infection, to review the literature on LBWC pathogenesis and risk factors, and to generate hypotheses for future etiological research. Early prenatal diagnosis is crucial; however, cases may be detected late in settings with limited antenatal care. We report a 37-year-old multiparous woman in whom LBWC was diagnosed by ultrasonography at 24–25 weeks' gestation. Imaging revealed a large abdominal wall defect with exposed intestinal loops, spinal deformity, limb dysplasia, and a short umbilical cord — findings that were confirmed postnatally. Maternal assessment identified active HSV-1/2 infection and residence near gold-mining activities, suggesting possible environmental mercury exposure. LBWC remains a devastating and fatal congenital condition. This case emphasizes the critical role of early antenatal screening and highlights the need for further research exploring possible associations between LBWC, maternal infections, and environmental exposures, particularly mercury exposure in gold-mining areas.
Adelake, O., Gill, F., & Krishnan, R. (2021). Rare presentation of limb-body wall complex in a neonate: Case report and review of literature. AJP Reports, 12(1), E108–E112.
Al-Gubory, K. H., Fowler, P. A., & Garrel, C. (2010). The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes. International Journal of Biochemistry & Cell Biology, 42(10), 1634–1650. https://doi.org/10.1016/j.biocel.2010.06.001
Bhat, A., Ilyas, M., & Dev, G. (2016). Prenatal sonographic diagnosis of limb-body wall complex: Case series of a rare congenital anomaly. Radiology Case Reports, 11, 116–120. https://doi.org/10.1016/j.radcr.2016.02.001
Bose-O’Reilly, S., McCarty, K. M., Steckling, N., & Lettmeier, B. (2010). Mercury exposure and children’s health. Current Problems in Pediatric and Adolescent Health Care, 40(8), 186–215. https://doi.org/10.1016/j.cppeds.2010.07.002
Burton, G. J., & Jauniaux, E. (2004). Placental oxidative stress: From miscarriage to preeclampsia. Journal of the Society for Gynecologic Investigation, 11(6), 342–352. https://doi.org/10.1016/j.jsgi.2004.03.003
Charkiewicz, A. E., Omeljaniuk, W., Garley, M., & Nikliński, J. (2025). Mercury exposure and health effects: What do we really know? International Journal of Molecular Sciences, 26(5), 2326. https://doi.org/10.3390/ijms26052326
Chikkannaiah, P., Dhumale, H., Kangle, R., & Shekar, R. (2013). Limb body wall complex: A rare anomaly. Journal of Laboratory Physicians, 5(1), 65–67. https://doi.org/10.4103/0974-2727.115939
Clarke, E., Patel, R., Dickins, D., Fidler, K., Kingston, M., Jones, C., et al. (2024). Joint British Association for Sexual Health and HIV and Royal College of Obstetricians and Gynaecologists national UK guideline for the management of herpes simplex virus (HSV) in pregnancy and the neonate (2024 update). International Journal of STD & AIDS, 35(0), 1–20.
Cohen, J. T., Bellinger, D. C., & Shaywitz, B. A. (2005). A quantitative analysis of prenatal methyl mercury exposure and cognitive development. American Journal of Medical Genetics, 29, 353–365.
D’Souza, J., Indrajit, I., & Menon, S. (2004). Limb body wall complex. Medical Journal Armed Forces India, 60, 101–106.
Dutta, S., & Ruden, D. M. (2024). Heavy metals in umbilical cord blood: Effects on epigenetics and child development. Cells, 13(1775). https://doi.org/10.3390/cells13171775
Haddout, S., Ikouch, K., Jalal, M., Lamrissi, A., & Bouhya, S. (2022). A rare case of limb body wall complex. Radiology Case Reports, 17(10), 4013–4017. https://doi.org/10.1016/j.radcr.2022.07.066
Jayaram, P. R., Pereira, F. D., & Barrett, J. A. (2018). Evaluation of dynamic ultrasound scanning in the diagnosis of equivocal ventral hernias with surgical comparison. British Journal of Radiology, 91.
Król-Pakulska, E., & Pakulski, C. (2017). Mercury—A highly toxic element. Health Sciences, 4, 508–513.
Megli, C. J., & Coyne, C. B. (2022). Infections at the maternal–fetal interface: An overview of pathogenesis and defence. Nature Reviews Immunology, 20, 67–82.
Mulita, F., Parchas, N., Solou, K., Tchabashvili, L., Gatomati, F., Iliopoulos, F., et al. (2020). Postoperative pain scores after open inguinal hernia repair: Comparison of three postoperative analgesic regimens. Medical Archives, 74, 355–358. https://doi.org/10.5455/medarh.2020.74.355-358
Murad, M. H., & Wang, Z. (2017). Guidelines for reporting meta-epidemiological methodology research. BMJ Evidence-Based Medicine, 22(4), 139–142.
Nambiema, A., Sembajwe, G., Lam, J., Woodruff, T. J., Mandrioli, D., Chartres, N., Fadel, M., Le Guillou, A., Valter, R., & Deguigne, M. (2021). A protocol for the use of case reports/studies and case series in systematic reviews for clinical toxicology. Frontiers in Medicine, 8, 708380. https://doi.org/10.3389/fmed.2021.708380
Narayan, R., Meena, A., Sarkar, R., & Agrawal, M. (2024). A rare case report of limb body wall complex. Cureus, 16(4), 4–7. https://doi.org/10.7759/cureus.57985
Nyanza, E. C., Dewey, D., Manyama, M., Martin, J. W., & Hatfield, J. M. (2020). Maternal exposure to arsenic and mercury and associated risk of adverse birth outcomes in small-scale gold mining communities in Northern Tanzania. Environmental International, 173, 432–442.
Page, M. J., Shamseer, L., Altman, D. G., Tetzlaff, J., Sampson, M., Tricco, A. C., Catala-Lopez, F., Li, L., Reid, E. K., & Sarkis-Onofre, R. (2016). Epidemiology and reporting characteristics of systematic reviews of biomedical research: A cross-sectional study. PLoS Medicine, 13(5), e1002028. https://doi.org/10.1371/journal.pmed.1002028
Prasun, P., Behera, B. K., & Pradhan, M. (2008). Limb body wall complex. Indian Journal of Pathology and Microbiology, 51(2), 255–256.
Rice, K. M., Walker, E. M., Wu, M., Gillette, C., & Blough, E. R. (2014). Environmental mercury and its toxic effects. Journal of Preventive Medicine and Public Health, 47(2), 74–83. https://doi.org/10.3961/jpmph.2014.47.2.74
Ye, C. H., Li, S., & Ling, L. (2023). Analysis of characteristic features in ultrasound diagnosis of fetal limb body wall complex during 11–13+6 weeks. World Journal of Clinical Cases, 11(19), 4544–4552. https://doi.org/10.12998/wjcc.v11.i19.4544
Copyright (c) 2026 I Gde Hary Eka Adnyana, Dwi Andhika Panjarwanto, Prima Aulia Achsan, Agus Rusdhy Hariawan Hamid, Ario Danianto

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