Pregnant woman with unknown etiology 1:1 of three, HIV negative serology, had early latent syphilis diagnosed at week 28 of pregnancy (VDRL non-reactive at 12 weeks of gestation, positive VDRL-TPRL-228 a
Treated with your partner 3 weeks before starting labor.
She had no history of syphilis in previous pregnancies and a stable partner for more than 2 years.
She was admitted to the emergency department due to premature ovular rupture of 30 h of evolution with corticosteroids and 6 doses of ampicillin.
RPR was performed during delivery, which was non-reactive ( VDRL was not performed).
The newborn was born by vaginal delivery of 34 weeks, small for gestational age (SGA) weighing 1,920 g, with generalized tapering, without respiratory effort, APGAR 6-8, requiring positive pressure ventilation.
He presented with hyaline membrane disease (HMD) and surfactant; however, due to progressive respiratory compromise, he was connected to mechanical ventilation.
Seizures severe with high oxygen requirements, with deterioration of the general condition, generalized jaundice, multiple petechiae, bleeding in puncture sites and pulmonary hypertension were added.
Physical examination revealed: glomerulous abdomen, hepatomegaly palmobulous (ambos 3 cm below costal margin), petechiae, abdominal wall edema and extremities, and deplantation
Treatment was initiated with sodium penicillin and IV gentamicin due to suspected early sepsis.
The result of VDRL in the blood of the NB 1:64 was received, no lumbar puncture (LP) was performed at that time due to gravity and marked thrombocytopenia.
Initial laboratory tests are shown in Table 1.
1.
It was assumed probable diagnosis of congenital syphilis and early sepsis, it was decided to complete a study for research of multisystem damage.
Echocardiography, abdominal ultrasound and brain ultrasound were normal.
Blood cultures were negative.
Antibiotic treatment was completed with 7 days of IV gentamicin and 14 days of IV sodium penicillin, achieving a progressive decrease in vasoactive drugs until suspension.
In the context of elevated transaminases and hepatomegaly, a study was completed with negative serology for hepatitis B and C.
Cytomegalovirus (CMV) was not studied.
LP was performed at 28 days of life, resulting cytochemical normal cerebrospinal fluid (CSF) and non-reactive VDRL with 1:32 VDRL in blood.
Radiography of long bones and bottom of the eye showed no abnormalities.
During the first month of hospitalization, the patient presented favorable clinical signs and symptoms, with improvement in liver tests but with bad increment.
