Congenital Syphılıs: Case Report

Öz

Abstract

A newborn boy was admitted to the neonatal intensive care unit because of prematurity (31 weeks gestation), respiratory distress and hydrops. His birthweight was 1990grams. On physical examination; he was not looking well with skin edema, hypotonia, multiple petechia and purpura, distended abdomen and hepatosplenomegaly. As-cites was found on abdominal ultrasonography. Laboratory workup revealed leukocytosis, anemia, trombocytopenia, high liver function tests, direct hyperbilirubinemia, hyperferritinemia and high AFP levels. He was started on antibiotics, IVIG and othersupportive treatment with a diagnosis of sepsis or hemochromatosis. However, in hisTORCH tests, VDRL was high, upon which a TPHA test was sent, and it was also positive in very high titers. His mother and father was also tested for TPHA, which wereboth high. He was started on crystalized penicillin therapy and his parents were treated in the Infection department. His routine follow up and treatment for prematurityand related disorders were completed and he was discharged on day 69 of life. In suspected cases, we should always remember congenital syphilis in differential diagnosis even if there is no family history.

Anahtar Kelimeler

• congenital syphilis,VDRL,hydrops fetalis

Konjenital Sifiliz: Olgu Sunumu

Öz

Öz

31. gestasyonel haftada sezeryan ile 1990 gr ağırlığında doğan erkek bebek, yetersiz solunum çabası ve hidropik görüntüsü nedeniyle yenidoğan yoğun bakım ünitesinealındı. Fizik muayenesinde genel durumu çok kötü, cilt ödemli, hipotonik, vücutta yaygın peteşi ve ekimoz mevcuttu. Batın distandü idi ve hepatosplenomegalisi vardı. Batın ultrasonografisinde asit görüldü. Laboratuvar tetkiklerinde lökositoz, anemi, trombositopeni ve karaciğer fonksiyon testlerinde bozukluk, direkt hiperbilirubinemi, hiperferritinemi, AFP yüksekliği  saptandı.  Sepsis ve neonatal hemokromotoz ön tanıları ileantibiotik, IVIG ve destek tedavileri başlandı.  TORCH tetkiklerinde Venereal Disease Research Laboratory(VDRL) yüksek  saptanması üzere Treponema Pallidum Hemaglutinasyon Assay (TPHA) testi de yüksek titrede pozitif saptandı. Anne ve babası incelendi ve her ikisinde de TPHA testi yüksek titrede pozitif bulundu. Antibiotik tedavisikristalize penisilin olarak değiştirildi. Anne ve babası enfeksiyon bilim dalına yönlendirilerek tedavileri yapıldı. Prematürite açısından da gerekli bakım ve takipleri yapılanhasta postnatal 69. günde taburcu edildi. Aile öyküsü olmamasına rağmen şüpheli durumlarda konjenital sifiliz akılda tutulması gereken bir hastalıktır.

Anahtar Kelimeler

• konjenital sifiliz,VDRL,hidrops fetalis

Kaynakça

1. Kaynaklar 1.Sağlık Bakanlığı 2015 Bulaşıcı hastalıklar dairesi verileri. 2.Cooper JM, Sanches PJ. Congenital syphilis. Sem Perinatol2018; 42: 176-184 3.Hollier LM, Harstad TW, Sanches PJ et al Fetal syphlisi: cli-nical and laboratory characteristics. Obstet Gynecol 2001;97(6): 947-953 4.Dorfman DH, Glaser JH. Congenital syhilis presenting in in-fants after the newborn period. N Engl J Med 1990; 323 (19):1299-1302 5.Michelow IC, Wendel GR Jr, Norgard MV et al. Central ne-rovous system infection in congenital syphilis. N Eng J Med2002; 346 (23): 1792-1798 6.Mmeje O, Chow JM, Davidson L et al. Discordant syphilis im-munoassays in pregnancy: perinatal outcomes and implica-tions for clinical management. Clin Infect Dis 2015; 61 (7):1049-1053 7.Workowski KA, Bolan GA. Centers for Disease xcontrol andPrevention. Sexually transmitted diseases treatment guideli-nes, 2015. MMWR Recommendations and reports Morbidi-tiy and mortality weekly report Recommendations and reports.2015; 64(3RR): 1-137 8.Alexander JM; Sheffield JS, Sanches PJ et al. Efficacy of tre-atment for syphilis in pregnancy. Obstet Gynecol 1999;93(1): 5-8 9.Cooper JM, Michelow IC, Wozniak PS, Sanchez PJ. In thime:the persistence of congenital syphilis in BRazil_ more prog-ress needed. Rev Pauliste Peditar 2016; 34(3): 251-253