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Images in Paediatrics
From maternal chancre to pediatric intensive care
Del chancro materno a la terapia intensiva pediátrica
José Iván Castillo Bejarano, Michelle Trousselle Peralta, Samantha Pérez Cavazos
Corresponding author
samanthaperezc@gmail.com

Corresponding author.
, Abiel Homero Mascareñas de los Santos
Departamento de Pediatría/Servicio de Infectología Pediátrica, Hospital Universitario “Dr. José Eleuterio González”, Avenida Francisco I. Madero, Mitras Centro, Universidad Autónoma de Nuevo León, Monterrey, México
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a male infant aged 2 months who had been delivered vaginally in a public hospital at 36 weeks&#8217; gestation&#44; born to an untreated HIV-positive mother who was a drug user&#44; had not received prenatal care and had developed a painless perineal chancre in the second trimester of pregnancy that resolved spontaneously within 2 weeks&#44; with the mother not showing to the follow-up visit&#59; the venereal disease research laboratory test &#40;VDRL&#41; was nonreactive at the time of delivery&#46; The boy was asymptomatic at birth&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">He was admitted due to bloody nasal discharge and dermal lesions with onset one month prior&#46; The physical examination detected features suggestive of septic shock &#40;heart rate&#44; 180 bpm&#59; respiratory rate&#44; 50 bpm&#59; temperature&#44; 38&#46;8&#176;C&#41;&#44; a low weight of 2&#46;68<span class="elsevierStyleHsp" style=""></span>kg &#40;below the 3rd percentile&#44; with a <span class="elsevierStyleItalic">z</span>-score of &#8722;5&#46;5&#41;&#44; bloody nasal discharge&#44; cheilitis and generalised macular exanthema with hyperkeratosis and desquamation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; predominantly in the face&#44; trunk and extremities and with palmoplantar involvement &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; mild crepitus in the chest and abdomen and hepatosplenomegaly in absence of clinical features of ascites&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The findings of blood tests were reactive chemiluminescent immunoassay for detection of anti-<span class="elsevierStyleItalic">Treponema pallidum</span> antibodies &#40;25&#46;8 S&#47;CO&#41;&#44; anaemia &#40;haemoglobin&#44; 10<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#44; a leukocyte count of 9&#46;4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;mL&#44; thrombocytopenia &#40;95<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>&#47;mL&#41;&#44; hypoglycaemia &#40;58<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; transaminasaemia &#40;AST 554 U&#47;L&#44; ALT 135 U&#47;L&#41; with direct hyperbilirubinaemia &#40;3&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; hypoalbuminaemia &#40;1&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and an undetectable HIV viral load&#44; and the radiographs evinced periostitis in the long bones &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Examination of a lumbar puncture sample revealed hypoglycorrhachia &#40;28<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; hyperproteinorrhachia &#40;59<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; sin pleocytosis y VDRL reactivo&#46; The VDRL test in the mother was reactive &#40;1&#58;64&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient received a diagnosis of neurosyphilis and septic shock and was admitted for intensive care with initiation of a 14-day course of aqueous crystalline penicillin G sodium &#40;200 000 IU&#47;kg&#47;day&#41; that achieved a favourable outcome&#44; so the patient was discharged due to clinical improvement&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Depending on the timing of transmission&#44; syphilis can cause foetal death&#44; prematurity or low birth weight&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The case presented here demonstrates that no genital lesion should be neglected during gestation as it can have severe consequences for the offspring&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">We obtained informed consent in writing from the parents for the publication of clinical information and images&#46; A copy has been made available to the editor of the journal for review&#46;</p></span></span>"
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ISSN: 23412879
Original language: English
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Anales de Pediatría (English Edition)