Pediatric Infectious Disease

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VOLUME 6 , ISSUE 2 ( April-June, 2024 ) > List of Articles

CASE REPORT

Nonimmune Hydrops Fetalis and Early Skeletal Changes in Congenital Syphilis: Case Series and Review of Literature

Kruti N Shah, Shwetal Bhatt, Vaishali Chanpura

Keywords : Case report, Congenital syphilis, Early skeletal changes in congenital syphilis, Hydrops fetalis

Citation Information : Shah KN, Bhatt S, Chanpura V. Nonimmune Hydrops Fetalis and Early Skeletal Changes in Congenital Syphilis: Case Series and Review of Literature. Pediatr Inf Dis 2024; 6 (2):60-63.

DOI: 10.5005/jp-journals-10081-1427

License: CC BY-NC 4.0

Published Online: 15-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: Syphilis remains the most common congenital infection in the world. During pregnancy, syphilis is associated with numerous findings, including placentomegaly, hepatomegaly, polyhydramnios, fetal nonimmune hemolytic anemia, and hydrops fetalis. Typically, hepatomegaly and placentomegaly precede signs of hydrops fetalis on ultrasound. Abnormal antenatal ultrasound findings are associated with poor outcomes and a higher risk of neonatal treatment failure. In severe cases, syphilis infection during pregnancy leads to prematurity, low birth weight, and stillbirth. Some cases also present with early skeletal changes, and hence, skeletal radiographs expedite the clinical decision-making process and direct further management of neonates. The signs of neonatal syphilis, including hepatic and bone dysfunction, and fetal hemolytic anemia, do follow complete recovery with penicillin treatment. We hereby report two such cases of congenital syphilis presenting with nonimmune hydrops fetalis (NIHF) and early skeletal changes and aim to initiate early diagnosis and treatment based on clinical evidence. Case description: We report two cases of congenital syphilis with varied presentations. The first case presented as antenatally diagnosed hydrops fetalis with nonimmune hemolytic anemia and thrombocytopenia without any antenatal maternal diagnosis of syphilis. The baby also had features of neurosyphilis with early bony sclerotic changes. The patient responded to penicillin treatment. The other case was also an antenatally undiagnosed case of congenital syphilis with fetal anemia, thrombocytopenia, and hydrops fetalis, along with facial deformity and bony changes of sclerosis, addressing early syphilis but succumbed to death within 24 hours, accounting for hemodynamic instability and pulmonary hemorrhage. Conclusion: Congenital syphilis can remain undiagnosed in the antenatal period and, when left untreated, can present with life threatening complications. Due to varied clinical signs and presentations of congenital syphilis, it becomes imperative to diagnose it postnatally for early initiation of treatment. Long bone radiographs aid in the diagnosis of congenital syphilis in neonates of seronegative mothers. Clinical significance: Congenital syphilis may present with varied clinical presentations, such as hydrops fetalis, fetal growth restriction, anemia, thrombocytopenia, purpura, hepatosplenomegaly, meningitis, sclerotic bony changes, facial deformities, etc. Familiarity with the radiographic findings of early congenital syphilis can assist clinicians in making appropriate treatment decisions, especially in equivocal cases and prevent postnatal life-threatening events. Early treatment has been observed to reverse life-threatening complications. Repeat screening for syphilis in the later part of pregnancy is a prudent measure to avoid vertical transmission of syphilis.


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