A 1-hour-old boy is brought to the nursery for evaluation. The mother arrived at the hospital in labor; she received no prenatal care but says that the pregnancy was uncomplicated. As a result of a category III fetal heart rate tracing, the patient was born via cesarean delivery and had a strong cry and good muscle tone immediately after delivery. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. On examination, he is at the 5th percentile for weight, 3rd percentile for length, and 8th percentile for head circumference. Auscultation of the heart and lungs is unremarkable. Hepatosplenomegaly is present. Over the next several days, the patient develops jaundice, clear rhinorrhea, and a maculopapular rash on the feet and buttocks that later desquamates. This patient most likely has which of the following congenital infections?

Question

A 1-hour-old boy is brought to the nursery for evaluation.  The mother arrived at the hospital in labor; she received no prenatal care but says that the pregnancy was uncomplicated.  As a result of a category III fetal heart rate tracing, the patient was born via cesarean delivery and had a strong cry and good muscle tone immediately after delivery.  Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.  On examination, he is at the 5th percentile for weight, 3rd percentile for length, and 8th percentile for head circumference.  Auscultation of the heart and lungs is unremarkable.  Hepatosplenomegaly is present.  Over the next several days, the patient develops jaundice, clear rhinorrhea, and a maculopapular rash on the feet and buttocks that later desquamates.  This patient most likely has which of the following congenital infections?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d6d5_b76a_bc81_775fbb830109_MD0003_00 This patient has a congenital infection, which can cause nonspecific findings of jaundice and hepatosplenomegaly (due to fetal reticuloendothelial activation) as well as growth restriction (due to fetal inflammation). As seen in this patient, symmetric growth restriction (ie, proportional head circumference, body weight, and length restriction) is typical and suggestive of early (ie, first trimester) transplacental transmission of the pathogen, which usually results in more severe neonatal disease. Although classically associated with rubella, blueberry muffin rash (representing extramedullary hematopoiesis) is another nonspecific finding that can also be seen in any congenital infection. The most likely etiology in this patient is congenital syphilis, which can be asymptomatic at birth or present with specific findings in the neonatal period: Copious clear, purulent, or serosanguineous rhinorrhea (snuffles) A diffuse maculopapular or bullous rash that often involves the buttocks, legs, and soles and may desquamate Long bone abnormalities on x-ray (eg, metaphyseal lucencies, tibial destruction) Routine prenatal care, which did not occur in this case, usually identifies maternal syphilis via serologic testing, and maternal penicillin treatment can prevent most cases of congenital syphilis. Affected infants, typically of undiagnosed or inadequately treated mothers, warrant penicillin therapy to prevent late manifestations of disease (eg, saddle nose, Hutchinson teeth, and saber shins). saddle nose Hutchinson teeth saber shins (Choices A, C, and E) Congenital cytomegalovirus (CMV), rubella, and toxoplasmosis may present with hepatosplenomegaly, jaundice, and symmetric growth restriction. CMV is associated with periventricular calcifications; toxoplasmosis causes diffuse intracranial calcifications; and congenital rubella classically presents with the triad of sensorineural hearing loss, cataracts, and heart defects (eg, patent ductus arteriosus). However, none of these infections causes a desquamating rash or rhinorrhea. (Choice B) Infants with congenital HIV infection are usually asymptomatic in the neonatal period and typically develop failure to thrive, chronic diarrhea, and lymphadenopathy later in infancy. Educational objective: Nonspecific signs of congenital infection include jaundice, hepatosplenomegaly, and symmetric growth restriction. Specific findings highly suggestive of congenital syphilis include snuffles (copious rhinorrhea) and a maculopapular or bullous rash that may desquamate. References: A review of the guidelines for the evaluation and treatment of congenital syphilis. (http://www.ncbi.nlm.nih.gov/pubmed/25996197) TORCH complex. (http://www.ncbi.nlm.nih.gov/pubmed/32809363)

A 1-Hour-Old Boy Is Brought to the Nursery for Evaluation