1 Obstetrics & Gynecology, Simon Bolivar General Hospital, Ocumare del Tuy, Miranda ; Collaborative Group of Clinical Infectious Diseases Research, Caracas, Venezuela
2 Ophthalmology Department, Simon Bolivar General Hospital, Ocumare del Tuy, Miranda, Venezuela
3 Pediatrics Department, Maternal-Children Hospital, Macuto, Vargas, Venezuela
4 Collaborative Group of Clinical Infectious Diseases Research, Caracas, Venezuela
5 Ophthalmology Department, Caracas Universitary Hospital, Caracas, Venezuela

Abstract

Congenital microphthalmos and anophthalmos are currently considered rare conditions. Many infectious agents have been previously associated with these pathologies, but rarely Treponema pallidum. We report a case of bilateral microphthalmos in which her mother presented gestational syphilis.

Keywords: Syphilis; Microphthalmos; Anophthalmos; Pregnancy

Congenital microphthalmos and anophthalmos are rare conditions in which orbital growth is deficient.[1] The overall prevalence of congenital anophthalmos and microphthalmos has been estimated at 1 to 1.5 per 10,000 births,[1],[2] with a normal sex distribution. Microphthalmos is unilateral in three-quarters of cases and no consistent hereditary basis has been found.[1] Extrinsic causes such as maternal rubella or environmental teratogens are often suspected.[3] Other infectious agents such as toxoplasmosis, herpes, rubella and cytomegalovirus have been previously associated,[4],[5] but rarely Treponema pallidum.[6],[7] For these reasons we report a case of bilateral microphthalmos in which her mother presented gestational syphilis.

Case Report

A 3100-g female infant was born after 38 weeks gestation. The mother, a 17-year-old woman (gravida II, para II), underwent a normal delivery. At 8 gestational weeks, the pregnancy was complicated by a 1-week long maternal flulike illness consisting of fever. Results of serological testing for venereal disease research laboratory (VDRL) and IgG fluorescent treponemal antibody absorbance (FTA-ABS) tests were positive (IgM negative); and a 1/16 titer positive hemagglutination assay - Treponema pallidum test. The patient had no previous history of genital or other syphilitic lesions as well other possible infectious and environmental teratogens exposure, such as rubella, toxoplasmosis or additional intra-uterine infections. Mother was initially treated with benzathine penicillin G (non-specified dose). After this, the mother referred never returns for prenatal periodical evaluations. This pregnant woman presented to us on February 2005, for delivery. Physical examination at birth revealed that the infant was noted to have low ears implantation and bilateral microphthalmos Figure1Figure2 Examination of the skin revealed vesicular skin lesions involving the hands, neck, and genitals. The oral mucosa and nails were normal. Weight and length at birth were over to the 50th percentile of national growth curves, and head circumference was at the 25th percentile. A complete clinical evaluation showed no other systemic alterations. The WBC count was 7100 cells/mm 3sub , with 19% polymorphonuclear neutrophils, 77% lymphocytes, 0% monocytes, and 4% eosinophils. The hematocrit was 46%, the platelet count was 215 platelets/mm 3sub , and the caryotype was normal (46XX). The child's and mother's results (after delivery) of serological testing for VDRL and IgG FTA-ABS tests were positive (IgM negative); and a 1/2 titer positive hemagglutination assay- Treponema pallidum test, for birth. Child's treatment was aqueous crystalline penicillin G (50,000 u/Kg/dose IV q8-12h x 14 d). Mother was treated with benzathine penicillin G (2.4 mU IM x 2). After 4 months of follow-up, serological tests are negative for both. Now, the child is under evaluation for possible surgical management of microphthalmos.[1]