Levine Z, Sherer D M, Jacobs A, Rotenberg O
The Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, New York 10461, USA.
Am J Perinatol. 1998 Apr;15(4):233-6. doi: 10.1055/s-2007-993933.
We present an unusual case, in which a woman presenting with markedly decreased fetal movements at 29 weeks gestation following a recent increase in fundal height was noted sonographically to have fetal hydrops consisting of scalp edema, marked hepatomegaly, ascites, and polyhydramnios. No lethal structural congenital anomaly was noted. Admission laboratory examinations revealed a negative antibody screen and a negative RPR. Emergent cesarean section was performed due to prolonged fetal bradycardia during biophysical profile testing. The acidotic hydropic neonate weighing 1825 g was resuscitated yet succumbed at 3 hr of life following intravenous administration of antibiotics. Neonatal blood was RPR positive at 1:16. Postmortem pathology examination demonstrated severe multiorgan system failure secondary to overwhelming congenital syphilis. Extensive extramedullary hematopoiesis was noted and histopathology with Dieterle stains revealed numerous hepatic spirochetes. Postpartum reexamination of the maternal blood with serial dilutions revealed a positive RPR at 1:1024. This case emphasizes that initial negative screening for syphilis may be seen despite overwhelming infection, a condition that has been termed the "prozone effect."
我们报告一例罕见病例，一名妊娠29周的女性，近期宫高增加后出现明显的胎动减少，超声检查发现胎儿水肿，包括头皮水肿、明显肝肿大、腹水和羊水过多。未发现致命的结构性先天性异常。入院实验室检查显示抗体筛查阴性和快速血浆反应素环状卡片试验（RPR）阴性。由于生物物理评分测试期间出现长时间胎儿心动过缓，进行了紧急剖宫产。体重1825g的酸中毒水肿新生儿经复苏，但在静脉注射抗生素后3小时死亡。新生儿血液RPR为1:16阳性。尸检病理检查显示，因先天性梅毒感染严重导致多器官系统严重衰竭。发现广泛的髓外造血，Dieterle染色的组织病理学显示肝脏有大量螺旋体。产后对母体血液进行系列稀释复查，结果显示RPR为1:1024阳性。该病例强调，尽管感染严重，但梅毒初筛可能呈阴性，这种情况被称为“前带效应”。
