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
, Abiel Homero Mascareñas de los Santos
Corresponding author
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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Madero, Mitras Centro, Universidad Autónoma de Nuevo León, Monterrey, México" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Del chancro materno a la terapia intensiva pediátrica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1856 "Ancho" => 1389 "Tamanyo" => 232244 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Generalised desquamative dermatosis with palmoplantar involvement and hyperkeratotic patches in flexion areas. Lower extremity hypotrophy.</p>" ] ] ] "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’ gestation, born to an untreated HIV-positive mother who was a drug user, had not received prenatal care and had developed a painless perineal chancre in the second trimester of pregnancy that resolved spontaneously within 2 weeks, with the mother not showing to the follow-up visit; the venereal disease research laboratory test (VDRL) was nonreactive at the time of delivery. The boy was asymptomatic at birth.</p><p id="par0010" class="elsevierStylePara elsevierViewall">He was admitted due to bloody nasal discharge and dermal lesions with onset one month prior. The physical examination detected features suggestive of septic shock (heart rate, 180 bpm; respiratory rate, 50 bpm; temperature, 38.8°C), a low weight of 2.68<span class="elsevierStyleHsp" style=""></span>kg (below the 3rd percentile, with a <span class="elsevierStyleItalic">z</span>-score of −5.5), bloody nasal discharge, cheilitis and generalised macular exanthema with hyperkeratosis and desquamation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) predominantly in the face, trunk and extremities and with palmoplantar involvement (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), mild crepitus in the chest and abdomen and hepatosplenomegaly in absence of clinical features of ascites.</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 (25.8 S/CO), anaemia (haemoglobin, 10<span class="elsevierStyleHsp" style=""></span>g/dL), a leukocyte count of 9.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/mL, thrombocytopenia (95<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/mL), hypoglycaemia (58<span class="elsevierStyleHsp" style=""></span>mg/dL), transaminasaemia (AST 554 U/L, ALT 135 U/L) with direct hyperbilirubinaemia (3.7<span class="elsevierStyleHsp" style=""></span>mg/dL), hypoalbuminaemia (1.3<span class="elsevierStyleHsp" style=""></span>g/dL) and an undetectable HIV viral load, and the radiographs evinced periostitis in the long bones (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Examination of a lumbar puncture sample revealed hypoglycorrhachia (28<span class="elsevierStyleHsp" style=""></span>mg/dL), hyperproteinorrhachia (59<span class="elsevierStyleHsp" style=""></span>mg/dL), sin pleocytosis y VDRL reactivo. The VDRL test in the mother was reactive (1:64).</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 (200 000 IU/kg/day) that achieved a favourable outcome, so the patient was discharged due to clinical improvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Depending on the timing of transmission, syphilis can cause foetal death, prematurity or low birth weight.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</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.</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.</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. A copy has been made available to the editor of the journal for review.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2174 "Ancho" => 1675 "Tamanyo" => 232069 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Generalised macular erythematous exanthema. Abdominal distension due to hepatosplenomegaly.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1856 "Ancho" => 1389 "Tamanyo" => 232244 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0095" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Generalised desquamative dermatosis with palmoplantar involvement and hyperkeratotic patches in flexion areas. Lower extremity hypotrophy.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1268 "Ancho" => 1297 "Tamanyo" => 82578 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Periostitis in the long bones.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital syphilis, the great imitator-case report and review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.W. Keuning" 1 => "G.A. Kamp" 2 => "D. Schonenberg-Meinema" 3 => "J.W. Dorigo-Zetsma" 4 => "J.M. van Zuiden" 5 => "D. Pajkrt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(20)30268-1" "Revista" => array:7 [ "tituloSerie" => "Lancet Infect Dis." "fecha" => "2020" "volumen" => "20" "numero" => "7" "paginaInicial" => "e173" "paginaFinal" => "e179" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32502432" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptomatic congenital syphilis in a tertiary neonatal unit in Cape Town, South Africa: high morbidity and mortality in a preventable disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Pillay" 1 => "L.J. Tooke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7196/SAMJ.2019.v109i9.13817" "Revista" => array:6 [ "tituloSerie" => "S Afr Med J." "fecha" => "2019" "volumen" => "109" "numero" => "9" "paginaInicial" => "652" "paginaFinal" => "658" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000006/v2_202407150516/S2341287924000516/v2_202407150516/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000006/v2_202407150516/S2341287924000516/v2_202407150516/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287924000516?idApp=UINPBA00005H" ]
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