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A5605 - A Rare Cause of Neonatal Respiratory Failure and Diffuse Pulmonary Infiltrates - Congenital Syphilis of the Lung Rises Again?
Author Block: H. Hong, R. Kretzmer, M. Bansal; Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States.
INTRODUCTION: Congenital syphilis prevalence had been decreasing from 2008-2012 in the United States; however, from 2012-2016 there was a dramatic increase in the national congenital syphilis rate with approximately 15.7 cases per 100,000 live births. Pulmonary manifestations of congenital syphilis are uncommon but have been described as a cause of respiratory distress. We present a newborn infant with respiratory failure attributed to pulmonary disease from congenital syphilis and interesting radiographic findings. CASE: A 28-week gestation male infant born to substance abusing mother with no prenatal care developed respiratory failure needing surfactant and prolonged ventilator support. Neonatal course was significant for persistent pulmonary hypertension of the newborn and sepsis. Initial chest film revealed bilateral interstitial opacities. He had a reactive RPR titer, a positive CSF VDRL titer, and radiographic changes of his long bones consistent with congenital syphilis. He was treated with 14 days of penicillin. His CXR findings evolved to show increased bilateral consolidation with interstitial thickening and perihilar patchy opacities. He was discharged at 4 months with 1/4LPM supplemental oxygen based off a polysomnography. On outpatient follow up he had a high resolution CT chest done for persistent wheezing at 10 months of age that demonstrated mild bronchiectasis with peribronchial thickening in the right upper lobe, multiple thin subpleural bands throughout the lungs and small areas of patchy airspace consolidation without ground glass opacities. He had a flexible bronchoscopy that demonstrated mild laryngomalacia with normal bronchoalveolar lavage and growth of Moraxella catarrhalis. Aspiration was ruled out via a normal swallow study. Repeat polysomnography at 18 months was normal, hence supplemental oxygen was discontinued. Previous pulmonary infiltrates improved over subsequent CXRs and he has remained asymptomatic. Therefore his initial presentation and abnormal radiographic findings were attributed to congenital syphilis of the lung. DISCUSSION: Congenital syphilis of the lung is a rare cause of neonatal respiratory distress and interstitial pulmonary infiltrates. It was described in the early 1920s to form fibrous tissue with resultant bronchiectasis on autopsies, and there have been descriptions of chest films of infants with syphilitic lung involvement having diffuse coarse nodular shadows with small to large nodules coalescing, forming larger areas of opacification that is distinguishable from other pulmonary diseases. It may be important to include congenital syphilis of the lung in the differential diagnosis for any newborn presenting with respiratory failure, diffuse interstitial infiltrates on chest radiograph and positive risk factors.