A 27-day-old healthy female infant was born.
34 year old mother's daughter with adequate prenatal care.
Eutocic delivery.
AGA, BW 2,900 g, Apgar 9-9, with no other perinatal history was observed.
The mother consulted for skin lesions in the perioral and perianal areas of five days of evolution.
The day before admission, fever (39 °C) and progressive general malaise were observed.
The patient was admitted to the ICU under regular conditions, hyporeactive, weighing 3,100 g, axillary temperature 36.5 °C, heart rate 162 beats/min, blood pressure 89/44 mm Hg, room oxygen saturation (AMA 67 mm Hg).
Physical examination revealed erythematous desquamative palmoplantar lesions in the right ear and fissures in the perioral region.
Distended abdomen with hepatomegaly of 5 cm below the costal margin and stenosis of 3 cm without other findings.
1.
Laboratory tests revealed anemia (hemate) 30%, leukocytosis (23.
100/mm3) and thrombus (110,000/mm3).
C-reactive protein (CRP) 183 mg/L, albumin 2.4 g/l, GOT 71 U/LPT 15 U/L, urinary albumin/L ratio normal, alkaline phosphatase 426 U/L protein (1,3 mg).
The diagnosis of sepsis of cutaneous origin was raised, starting antibacterial therapy with cefoxime and cloxacillin prior to taking cultures (blood, urine and CSF).
Abdominal ultrasound showed an enlarged liver.
She developed septic shock requiring resuscitation fluids (40 ml/kg in 1/2 h) and red blood cell transfusion (15 ml/kg), without the need for vasoactive amines.
During the first day of evolution, the leukocyte count rose to 45.
800/mm3 (lymphocytes 59%, monocytes 15%), platelet decrease to 73,000/mm3, severe hypoalbuminemia in 1.3 g/l and metabolic acidosis; complete urine without proteinuria.
Blood culture, urine culture and urine culture were negative.
Due to the aforementioned alterations, virological studies for HIV, cytomegalovirus, Eplostein and parvovirus were performed, which were negative.
Myelooproliferative pathology was ruled out.
After 48 h of evolution, RPR was performed (Rapid plasma regin) resulting reactive, so VDRL was requested that was positive at titers of 1:128 and VDRL 1:ilis in CSF was positive.
Skin lesions were compatible with syphilitic pemphigus and rage.
He was treated with sodium penicillin G 250,000 IU/kg/day i.v. every 6 h for 21 days, with no complications arising from its use.
A study with long bone x-ray showed a hyperlucid band metaliary, brain CT was normal and the fundus of non-observed eye; the otorhinolaryngological evaluation was normal.
The patient had a good clinical response, with improvement of hematological and cutaneous involvement and regression of visceromegaly.
She was discharged from the ICU after 13 days of evolution and from the hospital one month after admission.
Seven weeks after discharge, VDRL titers decreased (1:32) and negative blood and CSF VDRL tests were observed at five months.
At 12-month follow-up, the patient showed no sequelae.
A review of the maternal clinical history confirmed a non-reactive VDRL on two occasions (1st and 2nd trimester of pregnancy) and a RPR at the time of non-reactive delivery.
Maternal VDRL testing was positive for titers 1:32 and negative for HIV.
Both parents were referred to STI treatment.
