Produção Nacional
Revisado por pares
Pseudoparalysis of Parrot: A Diagnostic Aid in Congenital Syphilis
2017; Elsevier BV; Volume: 190; Linguagem: Inglês
10.1016/j.jpeds.2017.07.048
ISSN1097-6833
AutoresAnnelyse Araújo Pereira, Sandra Márcia Castro, Ranielly Ribeiro Venturini, Fernanda Oliveira César, Patrícia Marques Fortes, Paulo Sucasas Costa,
Tópico(s)Female Genital Mutilation/Cutting Issues
ResumoA 30-day-old female infant presented to the orthopedic emergency department with progressive upper limb paralysis over the last week, with no history of trauma or fever. She was born at term, cesarean delivery, with unremarkable physical examination at birth. The mother had adequate prenatal care, but the last trimester venereal disease research laboratory test result was not available. The infant had a markedly decreased spontaneous movement of the upper limbs, crying on active movement, with intense skin paleness. Hypothesis presumptive diagnosis of congenital syphilis was made and a workup revealed a white blood cell count of 16 700/mL and a normal cerebrospinal fluid; radiograph of upper extremities indicated periostitis. The patient was treated with parenteral penicillin. She gradually improved, and after 10 days of treatment, she was asymptomatic, with no pain under passive or active movement. She was discharged with a marked return of movements (Figure; Video; available at www.jpeds.com) for outpatient follow-up. The parents were treated with benzathine penicillin. Syphilis has reemerged as a global public health problem. The incidence of congenital syphilis has increased in the last decade, with social impact in many countries, even in developed countries.1Bowen V. Su J. Torrone E. Kidd S. Weinstock H. Increase in incidence of congenital syphilis - United States, 2012-2014.MMWR Surveill Summ. 2015; 64: 1241-1245Google Scholar Congenital syphilis is attributable to the transmission of Treponema pallidum from the mother to the fetus transplacentally at any time during gestation. The increased risk is highest with recent infection, higher maternal Treponema titers, and delayed treatment, whether incomplete or inadequate.2Neu N. Duchon J. Zachariah P. TORCH infections.Clin Perinatol. 2015; : 77-103Abstract Full Text Full Text PDF PubMed Scopus (164) Google Scholar Congenital syphilis may lead to Parrot pseudoparalysis, first described by Jules Marie Parrot in 1871, characterized by decreased movement, mainly in the upper limbs, because of intense pain caused by local periostitis. This principally affects the metaphysis of long bones, with radiographic alterations in up to 95% of the patients with clinical signs of the disease.3Agrawal P.G. Joshi R. Kharkar V.D. Bhaskar M.V. Congenital syphilis: the continuing scourge.Indian J Sex Transm Dis. 2014; 35: 143-145Crossref PubMed Scopus (6) Google Scholar It may be misdiagnosed with a wide range of neonatal diseases with limb involvement, including birth trauma.4Vashisht D. Baveja S. Eponyms in syphilis.Indian J Sex Transm Dis. 2015; 36: 226-229Crossref PubMed Scopus (3) Google Scholar Between 60% and 80% of infants present with skeletal abnormalities. The treatment of choice is penicillin for 10 days.5Kwak J. Lamprecht C. A review of the guidelines for the evaluation and treatment of congenital syphilis.Pediatr Ann. 2015; 44: e108-14Crossref PubMed Scopus (20) Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwYWNkNzgzYzA3ZTYxZDYyNWEyYzgwZWU1NTc1YjhkYiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5MjAxMDM5fQ.c-YNhLih55cyr02_UXJ9kTAUWVHtR63BeQR0KhxWON5nyBICtTGczZ74k7PGV6xCiQMyQ1DXxC5OtGdY_PS9qtWy3aoVXJHVJwOCNT3smPekp7qsoo21JYiKX56X34EAJCqR8RZ-g_AFCYdpwHqdpXB8JZ9f9xhYZHB9O5eURAY5a3QudJKTOH7YJ3u4XhJDbKVQ9IGeTR9pKeqlaZYSr-4oN_K3KnzAglbqYXGUUsf6Z6c1IZqpFXVooy0h96vNEm1UJYmPzmeEt1PiWMo_xEPgpolW0sUjesY962frGkrn6cndpXjhTk6oZzFT_SyU4qUa_PPqaJ0xWk1THD9Tjw Download .mp4 (14.47 MB) Help with .mp4 files VideoCongenital syphilis before and after treatment. Recovery of pseudoparalysis of Parrot in an infant with congenital syphilis, before and after treatment with penicillin.
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