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Question

Difficulty: MediumNeonatal Disorders

An infant boy born at home at 3838 weeks gestation is evaluated in the pediatric clinic at 44 weeks of life. His mother recently emigrated and received no prenatal care. The parents report the infant has had a persistent, thick, blood-tinged nasal discharge for the past week. Two days ago, a peeling rash developed on his hands and feet. On examination, the infant is irritable but afebrile. Copious purulent rhinorrhea is noted. There is a maculopapular, desquamating rash prominent on the bilateral palms and soles. The abdomen is distended, and the liver edge is palpable 3 cm3\text{ cm} below the right costal margin. The spleen is also palpable. Which of the following is the most appropriate targeted pharmacotherapy for this patient's underlying condition?

  1. Intravenous aqueous crystalline penicillin GAnswer
  2. B
    Intravenous ampicillin and gentamicin
  3. C
    Intravenous acyclovir
  4. D
    Topical mupirocin and oral cephalexin
  5. E
    Reassurance and supportive care with saline nasal drops

Answer

Intravenous aqueous crystalline penicillin G
The correct answer provides the definitive treatment for early congenital syphilis. This infant's presentation of persistent, thick, blood-tinged rhinorrhea ('snuffles'), a desquamating maculopapular rash on the palms and soles, and significant hepatosplenomegaly in the context of no maternal prenatal care is highly specific for congenital Treponema pallidum infection. The standard, definitive standard of care for a symptomatic infant with congenital syphilis is a 10-day course of intravenous aqueous crystalline penicillin G.

Step-by-Step Solution

1
Analyze the maternal history and timing of symptoms.
The mother had no prenatal care, placing the infant at high risk for undiagnosed congenital infections. Symptoms presenting in the first month of life strongly suggest an intrauterine or perinatal infection.
Establishing the risk profile helps prioritize congenital infections in the differential diagnosis.
2
Evaluate the clinical triad of symptoms.
The infant has blood-tinged, purulent rhinorrhea ('snuffles'), a maculopapular and desquamating rash heavily involving the palms and soles, and hepatosplenomegaly.
These physical examination findings form the pathognomonic triad of early symptomatic congenital syphilis.
3
Identify the definitive pharmacologic treatment for the diagnosed condition.
Symptomatic congenital syphilis requires a 10-day course of intravenous aqueous crystalline penicillin G to eradicate the Treponema pallidum spirochete.
Recognizing the specific infectious syndrome allows the provider to select targeted, definitive antimicrobial therapy rather than empiric broad-spectrum coverage.

Key Concept

Early congenital syphilis classically presents with copious blood-tinged rhinorrhea ('snuffles'), a maculopapular and desquamating rash on the palms and soles, and hepatosplenomegaly. The definitive treatment for symptomatic infants is intravenous aqueous crystalline penicillin G.
Estimated Time:1m 0s
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Topics

Neonatal Disorders

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