Presentaciones de la sífilis anorrectal: la gran simuladora / Anorectal syphilis presentations: the great pretender

Antecedentes: La sífilis es una infección sexualmente transmisible sistémica crónica que afecta a docenas de millones de personas al año. A nivel anorrectal, su manifestación polimórfica obliga al diagnóstico diferencial con enfermedades anorrectales benignas y malignas. Objetivo: Describir las diferentes presentaciones de la sífilis anorrectal a propósito de 5 casos clínicos. Método: Estudio observacional, retrospectivo, descriptivo. Resultados: La mayoría de los pacientes fueron VIH positivos en edad sexual activa. Las manifestaciones registradas, al igual que las reportadas en la bibliografía fueron las fisuras, úlceras perianales y pseudotumores. Conclusiones: La sífilis es considerada "la gran simuladora". En la localización anorrectal se requiere una alta sospecha diagnóstica para diferenciarla de presentaciones similares de otras enfermedades anales benignas, la enfermedad inflamatoria intestinal y el cáncer anorrectal, con el fin de evitar el consiguiente riesgo de sobretratamiento. (AU)

Background: Syphilis is a chronic systemic sexually transmitted infection that affects tens of millions of people annually. At the anorectal level, its polymorphic manifestation requires differential diagnosis with benign and malignant anorectal diseases. Objective: To review the presentation of anorectal syphilis from 5 clinical cases. Methods: Observational, retrospective, descriptive study. Results: Most of the patients were HIV positive in sexually active age. The manifestations recorded and reported in the literature were fissures, perianal ulcers, and pseudotumors. Conclusions: Syphilis is considered "the great pretender". In anorectal syphilis, a high diagnostic suspicion is needed to differentiate it from similar presentations due to other anal conditions, inflammatory bowel disease, and anorectal cancer, to avoid the consequent risk of overtreatment. (AU)

Guía de Sífilis Gestacional y Congénita: perspectivas de profesionales de la salud en Bolívar (Colombia) / Guidelines on Gestational and Congenital Syphilis: insights of health professionals in Bolívar (Colombia)

Objetivos: Describir los conocimientos, la idoneidad y las prácticas respecto a la "Guía de práctica clínica (GPC) basada en la evidencia para la atención integral de la sífilis gestacional (SG) y congénita (SC)". Materiales y métodos: Estudio descriptivo de corte transversal. Incluyó médicos generales, especialistas y enfermeras que laboraban en 52 instituciones de salud en el departamento de Bolívar (Colombia) y realizan el control prenatal o la atención al neonato en el 2020. Muestreo por conveniencia. Se aplicó cuestionario digital que recolectó información sociodemográfica; evaluó conocimientos, idoneidad y prácticas sobre la "Guía de práctica clínica (GPC)" mencionada en los objetivos. Se hace análisis descriptivo. Resultados: Se incluyeron 101 trabajadores. Hay deficiencias relacionadas con la aplicación correcta del algoritmo inverso de diagnóstico (48 %) y seguimiento de SG (77 %), manejo de la paciente con antecedentes de alergias de manifestaciones sistémicas (31 %) y tratamiento de la SG (61 %) y SC (10 %). La recomendación de no aplicar prueba de penicilina en pacientes sin antecedentes de alergias sistémicas se considera poco útil (60 %). El 23 % de los trabajadores no emplea las pruebas rápidas y el 44 % de los especialistas da tratamiento para sífilis al compañero sexual. Conclusiones: Es importante intensificar las estrategias de capacitación en el personal de salud con énfasis en el personal de enfermería y, de manera urgente, empoderar a este personal en las actividades relacionadas con el control de la sífilis. Se requiere hacer nuevas y continúas evaluaciones a nivel nacional y regional de la implementación de esta guía que permitan evaluar los indicadores que contiene la estrategia de eliminación de esta enfermedad.

Objectives: To describe the knowledge, appropriateness and practices regarding the evidence-based "Clinical Practice Guidelines (CPG) for the comprehensive management of gestational syphilis (GS) and congenital syphilis (CS)". Material and methods: A descriptive, cross-sectional study including general practitioners, specialists and nurses working at 52 healthcare institutions in the Bolivar Department (Colombia) who provided prenatal control or neonatal care in 2020. Convenience sampling was used. A digital questionnaire was administered to collect sociodemographic information, assessed knowledge, appropriateness and practices in terms of the evidenced-based "Clinical Practice Guidelines (CPG)" mentioned in the objectives. A descriptive analysis followed. Results: A total of 101 workers were included. There are deficiencies associated with the correct use of the inverse algorithm of diagnosis (48 %) and GS follow-up (77 %), management of the patient with a history of systemic manifestation allergies (31 %) and treatment of GS (61 %) and CS (10 %). The recommendation of not using the penicillin test in patients with no history of systemic allergies is considered of little benefit (60 %). 23 % of the workers do not use rapid tests and 44 % of the specialists administer syphilis treatment to the sexual partner. Conclusions: It is important to intensify the training strategies for health personnel with emphasis on nurses and, as a matter of urgency, empower them in syphilis control activities. New and continuous national and regional evaluations of the implementation of these guidelines are needed to assess the indicators associated with the strategy for the elimination of this disease.

Evaluación del impacto de la pandemia de COVID-19 en el seguimiento y tratamiento de gestantes con sífilis y sus parejas: análisis comparativo con un período prepandémico / Evaluation of the impact of the COVID-19 pandemic onthe follow-up and treatment of pregnant women with syphilis and their partners: comparative analysis with a pre-pandemic period

Se realizó un estudio observacional descriptivo transver-sal retrospectivo de las gestantes con nuevo diagnóstico de sífilis atendidas en el Hospital Materno Infantil de San Isidro "Dr. Carlos Gianantonio" durante los años pandé-micos 2020-2021. Se asistieron 108 gestantes con sífilis: 69 en 2020 y 39 en 2021. El tratamiento de aquellas que finalizaron el embarazo al momento de realizar este estu-dio (n=95) fue adecuado en el 78% (74) de los casos, en el 16,8% (16) fue inadecuado y el 5,2 % (5) perdió el segui-miento. El 11% presentó reinfección durante el embarazo. Con respecto a las parejas (n=103), el 84,6% (88) tenía una relación estable; se testeó al 70% (73) de las parejas, de las cuales el 45% (33) tenía VDRL positiva y se trató al 88% (29). Los resultados del estudio no muestran diferencias significativas en los indicadores evaluados (tratamiento adecuado y reinfección de la gestante y testeo/tratamien-to de la pareja) al comparar los períodos prepandémico (2018-2019) vs. pandémico (2020-2021)

A retrospective cross-sectional descriptive observational study of pregnant women with a new diagnosis of syphilis treated at the San Isidro Maternity Hospital during the 2020-2021 pandemic years was carried out. 108 pregnant women with syphilis were assisted: 69 in 2020 and 39 in 2021. The treatment of those who ended their pregnancy at the time of this study (n=95) was adequate in 78% (74) of the cases, 16,8% (16) were inadequate and 5.2% (5) lost follow-up. 11% presented reinfection during pregnancy. Regarding the couples (n=103), 84.6% (88) had a stable relationship, 70% (73) of the couples were tested, of which 45% (33) had positive vdrl and were treated 88% (29). The results of the study do not show significant differences in the indicators evaluated (adequate treatment and reinfection of the pregnant woman and testing/treatment of the partner) when comparing the pre-pandemic (2018-2019) vs. pandemic (2020-2021) periods

Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report.

OBJECTIVE: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. METHODS: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. RESULTS: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. CONCLUSION: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission. MAIN RESULTS: First experience of the sub-national process of certification of elimination of mother-to-child transmission (MTCT) of HIV and/or syphilis at a global level. In 2022, 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants. IMPLICATIONS FOR SERVICES: The experience of sub-national certification of the EMTCT was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and surveillance and emerging as the main proponents in the process. PERSPECTIVES: Through this ongoing and dynamic initiative, there is an anticipation of over 100 municipalities and states joining in 2023. Sub-national certification aims to enhance comprehensive care for pregnant women, in order to achieve national certification of EMTCT.

Sífilis, VIH y hepatitis B en el binomio madre-hijo. Caracterización de casos atendidos en centros de tercer nivel del interior de Córdoba / Syphilis, HIV and hepatitis B in the Mother-Child binomial

ntroducción: Las infecciones perinatales pueden transmi-tirse al feto y al recién nacido. Sífilis, VIH y hepatitis B deben tamizarse durante la gestación.Objetivo: Conocer la incidencia, prevalencia y manejo de sífilis, VIH y hepatitis B en el binomio madre/hijo. Comparar resultados con estadísticas oficiales.Materiales y métodos: Estudio retrospectivo, descriptivo y analítico, mediante revisión de historias clínicas del Sana-torio de la Cañada y Hospital Pasteur, Villa María, Córdoba. Período 01/12/2020 al 31/07/2021. Resultados: Se estudiaron 870 embarazos, la incidencia de sífilis materna fue 52,87/1000 embarazos, 76,1% de las gestantes eran menores de 30 años y hubo 41% de diag-nósticos tardíos. La incidencia de sífilis congénita fue de 18,3/1000 RN vivos. La incidencia de VIH materno fue de 6,89/1000 embarazos, 66,7% tenían menos de 30 años y el 77,7% tuvo carga viral indetectable al parto. El 100% de los RN expuestos fueron estudiados, todos con carga viral indetectable al nacimien-to. No hubo casos de hepatitis B.Conclusión: 6,3% de las embarazadas presentaron al me-nos una serología reactiva y el mayor porcentaje diagnós-tico se centró en menores de 30 años. La incidencia de sífilis congénita superó la provincial y nacional (18,3 vs. 1,18 vs. 1,14). El porcentaje de positividad de VIH materno superó al provincial. No hubo transmisión vertical de VIH al nacimiento. La prevalencia de hepatitis B fue menor a las oficiales

Introduction: Perinatal infections can be transmitted to the fetus and new-born. Syphilis, HIV and Hepatitis B must be monitored during pregnancy.Objective: To know incidence, prevalence and management of syphilis, HIV and Hepatitis B in the mother/child binomial. To compare results with official statistics.Materials and methods: Retrospective, descriptive and analytical study, through the review of medical records from Sanatorio La Cañada and Hospital Pasteur in Villa Maria, Cordoba. Period 12/01/2020 to 07/31/2021.Results 870 pregnancies were studied, the incidence of maternal syphilis was 57.87/1000 pregnancies, 76.1% of pregnant women were under 30 years old, and there were 41% late diagnoses. The incidence of congenital syphilis was 18.3/1000 live newborns. The incidence of maternal HIV was 6.89/1000 pregnancies, 66.7% were women under 30 years old and 77.7% had undetectable viral load at birth. 100% of the exposed newborns were studied, all with undetectable viral load at birth. There were no cases of Hepatitis B.Conclusion: 6.3% of pregnant women presented at least one reactive serology and the highest diagnostic percentage was focused on those under 30 years old. The incidence of congenital syphilis exceeded the provincial and national data (18.3 vs 1.18 vs 1.14). The percentage of maternal HIV positivity was superior to the provincial one. There was no vertical transmission of HIV at birth. The prevalence of Hepatitis B was less than the official ones.

Sífilis congénita e infarto hepático, una asociación no reportada. Descripción de un caso pediátrico / Congenital syphilis and hepatic infarction, a not previously reported association. A pediatric case report

La sífilis congénita es causada por la infección del feto con Treponema pallidum durante el embarazo. Los síntomas son variables. Si bien es común el daño endotelial, no suele estar presente en los casos congénitos. Reportamos el caso de un lactante de 42 días de vida hospitalizado por masa abdominal. Las imágenes confirmaban la presencia de una lesión en el lóbulo hepático izquierdo sin efecto de masa. Las biopsias mostraron cambios compatibles con infarto y hepatitis neonatal. Las serologías del paciente y de su madre confirmaron el diagnóstico de sífilis congénita, y recibió tratamiento con penicilina intravenosa. El hígado se encuentra protegido de los daños isquémicos gracias a su doble irrigación, pero la acumulación de noxas puede haber provocado dicha presentación inusual. Tres meses más tarde, el paciente se encontraba libre de síntomas y la resonancia de control mostró atrofia del lóbulo izquierdo, mientras el resto del parénquima no presentaba alteraciones.

Congenital syphilis is caused by Treponema pallidum infection of the fetus during pregnancy. Symptoms are variable. While endothelial damage is common, it is not usually present in congenital cases. Here we report the case of a 42-day-old infant hospitalized due to an abdominal mass. Imaging studies confirmed the presence of an injury in the left lobe of the liver without mass effect. Biopsies showed changes compatible with infarction and neonatal hepatitis. The patient's and his mother's serologies confirmed the diagnosis of congenital syphilis, and he was treated with intravenous penicillin. The liver protected from ischemic injury by its double irrigation, but the accumulation of harmful agents may have caused this unusual presentation. Three months later, the patient was symptom-free, and the control MRI showed atrophy of the left lobe, while the rest of the parenchyma was unchanged.

Bone involvement in non-congenital syphilis / Compromiso óseo por sífilis no congénita

We documented two stages of bone involvement due to syphilis in two adult patients infected with human immunodeficiency virus. Bony lesions of secondary versus tertiary syphilis cannot be differentiated on clinical or radiologic grounds alone. Given the rarity of this clinical presentation, there is no consensus on treatment duration and related outcomes.

Se describen dos etapas de compromiso óseo por sífilis en dos pacientes adultos infectados por el virus de la inmunodeficiencia humana. Las lesiones óseas de la sífilis secundaria y de la sífilis terciaria no se pueden diferenciar únicamente por características clínicas o radiológicas. Dada la rareza de esta presentación clínica, no hay consenso sobre la duración del tratamiento y los resultados relacionados.

Sífilis infecciosa en la ciudad de Recreo, Departamento La Paz, Provincia de Catamarca, Argentina / Infectious syphilis in Recreo city, Department La Paz, Catamarca Province, Argentina

La sífilis, aun siendo fácil de diagnosticar y tratar, es causa de morbilidad y mortalidad en el mundo y su prevalencia sigue en aumento. Objetivos: Determinar la proporción de infectados con Treponema pallidum según sexo y edad y su relación con factores de riesgo. Métodos: 148 pacientes (47% varones, 53% mujeres, entre 16 y 60 años), pruebas de VDRL y ELISA, registro de datos demográficos, clínicos, conductas de riesgo. Resultados: primera prueba de VDRL en el 78,38% de los participantes. Casos de sífilis confirmados: 10 (6,76%); 70% mujeres, entre ellas 57,4% embarazadas; 70% entre 16 y 24 años de edad; 50% con nivel secundario completo y con VDRL previa; 70% con pareja sexual estable; edad temprana de inicio de actividad sexual (≤ 16); ausencia de uso de preservativo siempre. Conclusión: Se evidencia la necesidad de realizar controles serológicos e implementar un abordaje interdisciplinario en la prevención y tratamiento, principalmente en jóvenes[AU]

Syphilis, even easy to diagnose and treat, is a cause of morbidity and mortality in the world and its prevalence continues to increase. Objectives: To determine the proportion of infected with Treponema pallidum by sex and age and its relationship with risk factors. Methods: 148 patients (47% men, 53% women, between 16 and 60 years old), VDRL and ELISA tests, demographic and clinical data, risk behaviors record. Results: first VDRL test in 78.38% of patients. Syphilis cases: 10 (6.76%): 70% women, including 57.4% pregnant; 70% between 16 and 24 years of age; 50% completed secondary level and with previous VDRL; 70% stable sexual partner; early age of onset of sexual activity (≤ 16); absence of condom use always. Conclusion: it is evident the necessity of perform serological controls and interdisciplinary approach on prevention and treatment, mainly in young people[AU]

Sífilis, embora de fácil diagnóstico e tratamento, é causa de morbidade e mortalidade no mundo e sua prevalência continua aumentando. Objetivos: Determinar a proporção de pessoas infectadas pelo Treponema pallidum segundo sexo e idade e sua relação com fatores de risco. Métodos: 148 pacientes (47% homens, 53% mulheres, entre 16 e 60 anos), testes VDRL e ELISA, registro de dados demográficos e clínicos, comportamentos de risco. Resultados: primeiro teste de VDRL em 78,38% dos participantes. Casos de sífilis confirmados: 10 (6,76%); 70% mulheres, incluindo 57,4% grávidas; 70% entre 16 e 24 anos; 50% com nível médio completo e com VDRL anterior; 70% com parceiro sexual estável; idade precoce de início da atividade sexual (≤ 16); ausência de uso de preservativo sempre. Conclusão: Fica evidente a necessidade de realizar controles sorológicos e implementar uma abordagem interdisciplinar na prevenção e tratamento, principalmente em jovens[AU]

[Epidemiological situation of post-pandemic sexually transmitted infections in Catalonia, Spain]. / Situación epidemiológica de las infecciones de transmisión sexual pospandemia en Cataluña, España.

BACKGROUND: The growing trend of STIs in recent years was altered after the outbreak of the SARS-CoV-2 pandemic. OBJECTIVES: Describe the impact of the SARS-CoV-2 pandemic on STI declarations received during the pre-pandemic to pandemic period and estimate the number of STI cases expected for the pandemic period. MATERIAL AND METHODS: Descriptive analysis of STI declarations received during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. The influence of the number of positive cases of SARS-CoV-2 with the number of positive cases of STIs during the months of the pandemic was studied using a correlation model. Using the Holt-Wilson time series model, an estimate was made of the number of STI cases expected for the pandemic period. RESULTS: The global incidence rate for all STIs in 2020 decreased by 18.3% compared to 2019. Chlamydia and syphilis presented a greater reduction in their incidence from 2019 to 2020 of 22.7% and 20.9%, respectively and 9.5% and 2.5% for gonorrhea and LGV. Estimates showed that in 2020 there would have been 44.6% more STIs than those declared. The proportions according to sex, country of birth and sexual orientation changed significantly in chlamydia and gonorrhea. CONCLUSIONS: The measures adopted for the prevention of SARS-CoV-2 infections were able to achieve an initial decrease in STI cases in 2020, however, this change was not maintained during 2021, which ended with higher incidences recorded to date.

Sifílide opalina como única manifestación de la sífilis secundaria / Opaline syphilid as the only manifestation of secondary syphilis i: en

Se describe el caso clínico de un paciente de 62 años de edad, quien fue atendido en la consulta de dermatología del Policlínico Aquiles Espinosa Salgado de Las Tunas, por presentar una lesión blanca, de aspecto perlado, de 0,5 cm, en la punta de la lengua. Teniendo en cuenta las características de dicha lesión, se estableció el diagnóstico de sospecha de sífilis secundaria. Se le indicó la prueba serológica para la detección de sífilis, cuyo resultado fue de 128 diluciones, por lo que se confirmó que se trataba de una sifílide opalina, como manifestación de la sífilis en estadio secundario. Se efectuó el control de foco y la fuente de contagio estaba aún sin precisar. Con el tratamiento indicado evolucionó favorablemente, pero se mantuvo el seguimiento clínico y serológico según lo establecido.

The case report of a 62 years patient who was assisted in the Dermatology Service of Aquiles Espinosa Salgado Polyclinic in Las Tunas is described, who presented a 0.5 cm white lesion, of pearly aspect, in the tip of the tongue. Taking into account the characteristics of this lesion the suspected diagnosis of secondary syphilis was established. The venereal disease research laboratory test was ordered and its result was 128 dilutions, reason why an opaline syphilid was confirmed, as a manifestation of syphilis in secondary stage. The focus control was carried out and the source of infection was still without specifying. With the suitable treatment, he had a favorable clinical course, but clinical and serologic follow up was maintained as established.

[Primary care management of sexually transmitted infections (I). Epidemiology. Secreting syndrome]. / Manejo en atención primaria de las infecciones de transmisión sexual (I). Epidemiología. Síndrome secretor.

These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications. In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25years of age. In addition, an increase in the incidence of syphilis and hepatitisC (HCV) has also been detected, especially in men who have sex with other men (MSM). Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population. A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (<350CD4cell/µL). Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk. STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C.trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located. Gonococcus has an incubation period of 2-7days and Chlamydia 2-6weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities. Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1g single intramuscular dose plus doxycycline 100mg every 12h orally for 7days, or azithromycin 1g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy). Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitisB, and hepatitisA andC depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3months.

Sífilis ocular, "la gran simuladora" / Ocular syphilis, "the great pretender"

Introducción: La sífilis es una enfermedad de transmisión sexual causada por el Treponema pallidum. Reportes recientes de diferentes regiones del mundo sugieren que la sífilis ocular está reemergiendo en paralelo con el incremento de la incidencia de la infección sistémica a nivel global. Objetivo: Profundizar en el conocimiento sobre la sífilis, especialmente, en la sífilis ocular, que se encuentra en la bibliografía especializada. Métodos: Fundamentalmente se consultaron artículos de los últimos 5 años, en idioma español e inglés, disponibles en textos completos. Las bases de datos consultadas fueron: PubMed, SciELO y Google académico. Conclusiones: La sífilis ocular puede presentarse en cualquier estadío de la enfermedad e imitar diferentes afecciones inflamatorias oculares, por lo que debe tenerse presente en el diagnóstico diferencial de toda uveítis. El tratamiento oportuno de estos pacientes puede minimizar el daño visual, pero su diagnóstico es a menudo un desafío para el oftalmólogo(AU)

Introduction: Syphilis is a sexually transmitted disease caused by Treponema pallidum. Recent reports from different regions of the world suggest that ocular syphilis is re-emerging, in parallel with the increasing incidence of systemic infection globally. Objective: To deepen the knowledge on syphilis and especially ocular syphilis found in the specialized literature. Methods: The articles consulted were mainly from the last 5 years, in Spanish and English, available in full text. The databases consulted were PubMed, SciELO and Google academic. Conclusions: Ocular syphilis can present at any stage of the disease and mimic different ocular inflammatory conditions, so it should be taken into account in the differential diagnosis of any uveitis. Prompt treatment of these patients can minimize visual damage but its diagnosis is often a challenge for the ophthalmologist(AU)

Congenital syphilis and hepatic infarction, a not previously reported association. A pediatric case report. / Sífilis congénita e infarto hepático, una asociación no reportada. Descripción de un caso pediátrico.

Congenital syphilis is caused by Treponema pallidum infection of the fetus during pregnancy. Symptoms are variable. While endothelial damage is common, it is not usually present in congenital cases. Here we report the case of a 42-day-old infant hospitalized due to an abdominal mass. Imaging studies confirmed the presence of an injury in the left lobe of the liver without mass effect. Biopsies showed changes compatible with infarction and neonatal hepatitis. The patient's and his mother's serologies confirmed the diagnosis of congenital syphilis, and he was treated with intravenous penicillin. The liver is protected from ischemic injury by its double irrigation, but the accumulation of harmful agents may have caused this unusual presentation. Three months later, the patient was symptom-free, and the control MRI showed atrophy of the left lobe, while the rest of the parenchyma was unchanged.

La sífilis congénita es causada por la infección del feto con Treponema pallidum durante el embarazo. Los síntomas son variables. Si bien es común el daño endotelial, no suele estar presente en los casos congénitos. Reportamos el caso de un lactante de 42 días de vida hospitalizado por masa abdominal. Las imágenes confirmaban la presencia de una lesión en el lóbulo hepático izquierdo sin efecto de masa. Las biopsias mostraron cambios compatibles con infarto y hepatitis neonatal. Las serologías del paciente y de su madre confirmaron el diagnóstico de sífilis congénita, y recibió tratamiento con penicilina intravenosa. El hígado se encuentra protegido de los daños isquémicos gracias a su doble irrigación, pero la acumulación de noxas puede haber provocado dicha presentación inusual. Tres meses más tarde, el paciente se encontraba libre de síntomas y la resonancia de control mostró atrofia del lóbulo izquierdo, mientras el resto del parénquima no presentaba alteraciones.