Abstract Ref Number = APCP963
CONGENITAL SYPHILIS, A CASE SERIES
Dian Ayuningtyas,Nina Dwi Putri,Mulya Rahma Karyanti,Ari Prayitno,Hindra Irawan Satari
RSCM FKUI Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Background : Congenital syphilis (CS) is a serious disease which occurs by trans placental infection at any stage of pregnancy. The stage of maternal syphilis, gestational age of the fetus, adequacy of the maternal treatment and the immunological response of the fetus cause a variety of different clinical presentation. During 2017, we came across three neonates with unusual features during the hospital stay, which led to subsequent investigations and diagnosis of early congenital syphilis. All the mothers were apparently healthy and had uneventful antenatal period. None of them had any pre-pregnancy complication. None of the mothers were screened for syphilis during antenatal period.
Case Presentation Summary : Two out of three neonates were Low Birth Weight (LBW) cases, and all of them required resuscitation. In the first case, CS was confirmed through positive serology, hydrops fetalis, and hepatosplenomegaly features. In the second case, Infant presented generalized erythematous, targetoid, scaly macules, papules, pustules and desquamation at the hand and foot. In the third case, long bones x-ray showed lucent lesion in mid-diaphysis cortex at third left humerus and third right femur. Both VDRL mothers and infants were detected. The Treponema pallidum haemagglutination (TPHA) test were also positive in all cases. Infants were treated with intramuscular penicillin procaine (50,000 U/kg body weight/dose) for 10 days. The babies did not develop any further complication during hospitalization. Lesions disappeared during treatment. Growth and development was healthy during follow-up. Parents were referred to dermatology and venerology department for further follow up.
Learning Points/Discussion : The CS cases are like an iceberg phenomenon. Early diagnosis of CS in Indonesia is still a challenge since not all the pregnant women were screened for syphilis during pregnancy. Physician should aware for early clinical sign of CS. Prompt treatment will reduce long term sequelae.
Keywords: Syphilis Congenital Diagnosis