A 25-year-old pregnant woman presented with a three-year history of HIV-negative serology and VDRL test at 18 and 27 weeks of non-reactive protein.
She had no history of syphilis in previous pregnancies and a stable partner.
He was admitted to the Emergency Department due to metrorrhagia in the third trimester and symptoms of intraamniotic infection.
Amniocentesis was performed which showed purulent amniotic fluid, an aspect that, associated with an altered fetal record, determined to perform emergency cesarean section.
She received 1 dose of corticosteroids and 1 dose of cefazolin, ampicillin and gentamicin 1 h prior to delivery.
A 33-week-old PEG newborn weighing 1,595 g was born with poor respiratory effort, bradycardia, APGAR 3-6-8, covered with purulent secretion with meconium dye. Initially, poor respiratory effort was required.
She was admitted to the Neonatal ICU where globulous abdomen, erythematous macules some sunken in the abdomen and extremities, petechiae that progressed rapidly and signs of portal hypertension due to palmoplantar discharge are significant lesions
She was treated with ampicillin and gentamicin after blood collection.
1.
The result of maternal VDRL was 1:32, with positive MHA-TP being diagnosed as primary syphilis, since concomitant to this is rescue maternal record showing lesions in the genital area where the initial antibiotic scheme was 1:512, VDRL.
Due to marked clinical instability and previous clinical instability, LP was deferred until the seventh day of life, obtaining a cytochemical examination of CSF with 25 leukocytes, 40 mg/dl VDRL proteins in negative culture and laboratory problems 1:16.
Initial examinations are registered in Table 1.
Blood cultures and amniotic fluid cultures were negative.
He completed treatment with sodium penicillin for 14 days with confirmed congenital neurosyphilis diagnosis.
Prior to receiving the VDRL test result, a screening was requested with: PCR for Herpes virus 1 and 2 for skin lesions, PCR for CMV in urine, serology for HIV, hepatitis B, hepatitis C and toxoplasma resulting in
Echocardiography and abdominal ultrasound were normal and brain ultrasound at 2 weeks of life showed normal ventricles with germinal matrix reinforcement, bilateral intraventricular hemorrhage grade 1 and increased periventricular echogenicity.
Radiography of long bones and fundus of the eye showed no alterations.
Elevated liver function tests were observed during the first week of life.
After the second week of life, the patient evolved with significant clinical improvement.
At one month of life, her blood VDRL was 1:256.
She's been discharged after a month and a half of life.
