Disseminated Intravascular Coagulation with Intracranial Haematoma in Neonatal Congenital Syphilis

Grover, Shabnam Bhandari; Mahato, Simendra Kumar; Chellani, Harish; Saluja, Sumita; G, Rajalakshmi

doi:10.1093/tropej/fmq088

Cited by 6 publications

(2 citation statements)

References 3 publications

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“… [15] The penicillin therapy aggravated the liver dysfunction from syphilitic hepatitis, as shown by serum ALT levels specifically responding to penicillin dose changes (Table 1 ). The DIC may result from syphilitic vasculitis and syphilitic involvement of liver (hepatitis) and bone marrow (thrombocytopenia) [16] along with the immature coagulation and fibrinolytic systems with little reserve capacity in the preterm newborn state to be susceptible to this systemic thrombohemorrhagic disorder. [17] …”

Section: Discussionmentioning

confidence: 99%

Congenital syphilis unusually presenting with prematurity-related severe neonatal morbidities including meconium obstruction

Lee¹,

Lee

Jeon³

2020

Medicine

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Rationale: Congenital syphilis (CS) can manifest as a variety of clinical presentations according to the severity in symptomatic infants during neonatal period. Preterm neonates with CS may have more clinical evidences of infection and be more severely affected by CS compared with term ones. With increasing survival of markedly premature infants for recent decades, CS may be a challenging problem in those with severe manifestations associated with combined pathophysiologies of CS and prematurity. Patient concerns: A very low birth weight infant at 32 weeks gestation presented with an unusual CS presentation consisting of prematurity-associated severe neonatal morbidities including meconium obstruction, prolonged cholestatic jaundice with elevated liver enzymes, and disseminated intravascular coagulation with a bleeding diathesis, in addition to common or typical manifestations of CS. Diagnoses: Congenital syphilis. Interventions: Therapy consisting of a complete course of parenteral penicillin, blood component therapy, proximal ileotomy with inspissated meconium evacuation and distal loop ileostomy, and other conservative treatments. Outcomes: Resolution with normal gastrointestinal function and improved liver function was observed. Lessons: This case suggests that in premature infants CS may manifest as unusual severe neonatal morbidities that may result from combination of syphilitic pathologies and contributors or conditions associated with prematurity including multisystem immaturity.

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Section: Discussionmentioning

confidence: 99%

Congenital syphilis unusually presenting with prematurity-related severe neonatal morbidities including meconium obstruction

Lee¹,

Lee

Jeon³

2020

Medicine

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“…Recientemente Grover y cols. 31 , reportaron el segundo caso de CID neonatal ocasionada por sífilis congénita complicada con el desarrollo de un hematoma intracraneal. Otra complicación descrita y similar en su forma de presentación a la sepsis, fue comunicada por Pohl y cols.…”

Section: Discussionunclassified

Sífilis congénita: presentación como shock séptico después del período neonatal

Arriagada

Donoso

Cruces

et al. 2012

Rev. chil. infectol.

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Congenital syphilis presenting as septic shock alter the neonatal period Clinical spectrum of congenital syphilis ranges from asymptomatic infection to fulminant sepsis. Treponema pallidum is acquired crossing the placenta from the mother to the fetus during maternal spirochetemia or through direct contact of the child with an infected lesion at delivery. We report a 27 days-old previously healthy girl diagnosed with congenital syphilis. Her mother had an unremarkable previous history, adequate obstetric care and negative prenatal screening test for syphilis. The patient was brought to the ER due to development of skin lesions and fever in the last 24 h. She was admitted to pediatric ICU lethargic and poorly responsive, with hepatosplenomegaly and perioral, palmoplantar erythematous desquamative scaly lesions. Laboratory data revealed anemia, leukocytosis, thrombocytopenia and C-reactive protein of 183 mg/l. Soon after admission she developed septic shock with leukocytosis up to 45,800/mm3 and exacerbation of thrombocytopenia, hypoalbuminemia and metabolic acidosis. Congenital syphilis was diagnosed at the second day of admission with VDRL titers of 1:128 in serum and 1:8 in cerebrospinal fluid. Maternal serum VDRL was positive with titers of 1:32. The patient was treated with penicillin for three weeks with adequate clinical and laboratory response. Congenital syphilis is a life threating infection, but cannot always be diagnosed at birth. Health care workers must be aware of the difficulties in obtaining a definitive diagnosis and must have a high index of suspicion, considering the possible errors of prenatal serology and the diverse possible clinical presentations, including neonatal sepsis during the first month of life.Key words: Syphilis, congenital syphilis, sepsis, pediatrics. Palabras clave: Sífilis, sífilis congénita, sepsis, pediatría. IntroducciónL a sífilis congénita es una de las infecciones más antiguas de las cuales se tiene conocimiento, existiendo reportes desde el siglo XV 1,2 . Puede causar graves efectos en el feto en las distintas etapas de su crecimiento, desarrollo y organogénesis. La transmisión in utero de Treponema pallidum origina una diseminación del organismo en el feto, similar a una sífilis secundaria, describiéndose cambios patológicos tan precoces como a las 15 semanas de gestación 3 . Los sistemas y órganos más afectados son el esquelético, cerebro, hígado y pulmón 3 .Desde fines de los años 80 se ha comunicado un incremento en los casos de sífilis, lo que ha traído como consecuencia un aumento en la incidencia de sífilis congénita. La Organización Mundial de la Salud (OMS) estima que 12 millones de personas son infectadas con sífilis cada año y más de 90% de las infecciones ocurren en países en desarrollo 4 . La sífilis congénita es un problema relevante asociado a embarazos no controlados o infecciones tardías y refleja el comportamiento de la sífilis en general 5 . Ésta puede ocasionar: muerte fetal con aborto espontáneo o mortinato (30 a 40% de los casos), parto prematuro,...

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Fetal and neonatal abnormalities due to congenital syphilis: A literature review

et al. 2022

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Objective The recent recrudescence of syphilis among women of childbearing age is associated with an increasing number of cases of congenital syphilis. We aimed to summarize the fetal and neonatal abnormalities due to congenital syphilis infection, particularly signs amenable to prenatal diagnosis. Methods Eligible studies were retrieved from the PubMed collection database. Articles focusing on postnatal and antenatal abnormalities covered the periods from 1969 to 2019 and 1975–2019, respectively. This review included cohort studies, case series and case reports reporting findings regarding congenital syphilis infections described before and/or after birth. Articles were reviewed by three experts in prenatal diagnosis, and all findings were classified as amenable or not amenable to prenatal diagnosis. Results A total of 432 cases of congenital syphilis infection were reported. Abnormalities were described antenatally in 161 cases, postnatally in 319 cases, and in both the antenatal and postnatal periods in 57 cases. The most frequently reported signs amenable to prenatal diagnosis were abdominal abnormalities (hepatomegaly, splenomegaly, and bowel abnormalities), fetal growth restriction, and elevated middle cerebral artery peak systolic velocity in the context of ascites or atypical hydrops. Brain abnormalities were rare and never isolated. In the neonatal period, the most common abnormalities were hepatosplenomegaly, bone damage and skin lesions. Conclusion We found that no individual sonographic sign or pattern of signs is pathognomonic for fetal syphilis. In fetuses with ultrasound abnormalities suggestive of congenital infection, syphilis must be considered as part of the work‐up.

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Disseminated Intravascular Coagulation with Intracranial Haematoma in Neonatal Congenital Syphilis

Cited by 6 publications

References 3 publications

Congenital syphilis unusually presenting with prematurity-related severe neonatal morbidities including meconium obstruction

Congenital syphilis unusually presenting with prematurity-related severe neonatal morbidities including meconium obstruction

Sífilis congénita: presentación como shock séptico después del período neonatal

Fetal and neonatal abnormalities due to congenital syphilis: A literature review

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