Non-immune fetal hydrops fetalis with poor outcome: congenital Treponema infection. Case report
Non-immune fetal hydrops fetalis (NIPH) is defined as the presence of edema in the fetal skin and cavities, without evidence of antibodies against erythrocyte antigens. Its prevalence is 1/2,500-4,000 births. Among the infectious causes, the main differential diagnosis is with Parvovirus B19 (h...
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| Autores principales: | , , , , , , , |
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| Formato: | Artículo revista |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/39005 |
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| Sumario: | Non-immune fetal hydrops fetalis (NIPH) is defined as the presence of edema in the fetal skin and cavities, without evidence of antibodies against erythrocyte antigens. Its prevalence is 1/2,500-4,000 births. Among the infectious causes, the main differential diagnosis is with Parvovirus B19 (high tropism for erythroid cells and development of fetal anemia) although cases related to other infections have been described. It is report a case of HFNI with postmortem diagnosis by anatomic pathology caused by Treponema/syphilis.
23-year-old primigest, uncontrolled pregnancy. She consulted at 26 weeks of gestation (uterine height), normotensive, with no alterations in physical examination; ultrasound control: "single fetus, alive and mobile. Placenta of posterior insertion, homogeneous, normal amniotic fluid". Routine studies/surveys were requested (she did not return). At 31 weeks of gestation. Ultrasound: "Fetal movements and fetal heartbeat negative". Expulsion of dead fetus with generalized subcutaneous edema. Studies: group and factor: B Rh+, direct Coombs negative. Irregular antibodies negative. Rapid test for syphilis positive. VDRL Reactive 32 dils. Other serologies Negative. Pathological anatomy: generalized fetal epidermolysis and placenta with changes related to erythroblastosis and chorioamnionitis, compatible with infection by Treponema (HFNI). Warthin Starry staining was performed where spirochetes were visualized.
It is reported a case of NIPH with poor evolution associated to congenital syphilis. Although hydrops is a rare entity to diagnose, being even less frequent its association with Treponema infection, we reinforce the importance of prenatal controls and screening for an early diagnosis of a prevalent and easy to treat disease.
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