Pituitary gland gumma in congenital syphilis after failed maternal treatment: A case report

A preterm, very low birth weight infant was born to a mother with early lat ent syphilis who was treated 10 days and 3 days before delivery with 2.4 mU of benzathine penicillin The infant had clinical, laboratory, and radiogra phic abnormalities consistent with congenital syphilis, ie, a Venereal Dise ase Research Laboratory test titer that was fourfold greater than was the m aternal titer, hepatosplenomegaly, abnormal liver function tests, pneumonit is, osteochondritis of the long bones, and cerebrospinal fluid (CSF) examin ation showing a reactive Venereal Disease Research Laboratory test, pleocyt osis, and elevated protein content. The infant died on the third day of lif e, and an autopsy revealed an evolving gumma of the anterior pituitary. Imm unoglobulin M immunoblotting of serum and CSF was positive, and polymerase chain reaction detected Treponema pallidum DNA in endotracheal aspirate and CSF. This case highlights the pathologic abnormalities observed in congeni tal syphilis and focuses on the rare finding of an evolving anterior pituit ary gumma. Furthermore, it documents the failure of maternal syphilis treat ment during the last 4 weeks of pregnancy to cure fetal infection and suppo rts the recommendation that all infants born to mothers with syphilis treat ed during the last 4 weeks of pregnancy should receive penicillin therapy.