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Pituitary gland gumma in congenital syphilis after failed maternal treatment: a case report
A E Benzick1, D P Wirthwein, A Weinberg
1Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-9063, USA.
Insights
Maternal syphilis treatment late in pregnancy failed to prevent congenital syphilis in an infant. This case highlights a rare pituitary gumma and supports penicillin therapy for all high-risk infants.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Pathology
Background:
- Congenital syphilis poses significant risks to newborns.
- Maternal treatment for syphilis during pregnancy is crucial for fetal outcomes.
Observation:
- A preterm, low birth weight infant born to a mother treated late for syphilis presented with severe congenital syphilis.
- Clinical, laboratory, and radiographic findings were consistent with disseminated infection.
- Autopsy revealed an unusual anterior pituitary gumma.
Findings:
- The infant exhibited a fourfold higher VDRL titer than the mother.
- Treponema pallidum DNA was detected in infant's respiratory and cerebrospinal fluid.
- Despite maternal treatment, the fetus was infected, leading to severe disease and death.
Implications:
- This case underscores the limitations of late-stage maternal syphilis treatment in preventing fetal infection.
- It highlights the rare manifestation of congenital syphilis involving the anterior pituitary.
- Recommends penicillin therapy for all infants born to mothers treated for syphilis in the final trimester.
Abstract:
A preterm, very low birth weight infant was born to a mother with early latent syphilis who was treated 10 days and 3 days before delivery with 2.4 mU of benzathine penicillin. The infant had clinical, laboratory, and radiographic abnormalities consistent with congenital syphilis, ie, a Venereal Disease Research Laboratory test titer that was fourfold greater than was the maternal titer, hepatosplenomegaly, abnormal liver function tests, pneumonitis, osteochondritis of the long bones, and cerebrospinal fluid (CSF) examination showing a reactive Venereal Disease Research Laboratory test, pleocytosis, and elevated protein content. The infant died on the third day of life, and an autopsy revealed an evolving gumma of the anterior pituitary. Immunoglobulin M immunoblotting of serum and CSF was positive, and polymerase chain reaction detected Treponema pallidum DNA in endotracheal aspirate and CSF. This case highlights the pathologic abnormalities observed in congenital syphilis and focuses on the rare finding of an evolving anterior pituitary gumma. Furthermore, it documents the failure of maternal syphilis treatment during the last 4 weeks of pregnancy to cure fetal infection and supports the recommendation that all infants born to mothers with syphilis treated during the last 4 weeks of pregnancy should receive penicillin therapy.