Syphilis associated with abdominal trauma and splenic rupture in pregnancy

Abstract

We present a case of a pregnant woman in the third trimester who came to the Department of Emergency, Sf. Apostol Andrei Emergency County Hospital, Constanţa, Romania, in September 2016, for abdominal pain and ascites. After admission, the patient was periodically tested (biochemically and by ultrasound). We also payed attention to the fetal well-being. During the hospitalization, the patient was also found positive for syphilis. Biochemical values have progressively altered, the fetus started to present acute fetal distress and the patient gave birth by Caesarean section after two days of hospitalization. The intraoperatory surprise was hemoperitoneum caused by posttraumatic splenic rupture. The relevance of this case consists in its rarity (we were not able to find in the literature a case with the association of pregnancy, syphilis, trauma, and splenic rupture), in the difficult histopathological clear assertion and in the clinical awareness of such a condition.

Figure 1

Microscopic features of the spleen with hyalinized capsule and with intracapsular neutrophils (HE staining, ×40).

Figure 2

Microscopic features of the spleen with a subcapsular hematoma (HE staining, ×100).

Figure 3

Morphopathological features of the spleen with focal intraparenchymatous abscesses, plasma cells present in the red pulp, apoptotic bodies and tingible bodies macrophage appear in the marginal zone (HE staining, ×100).

Figure 4

Morphopathological features of the placenta with fibrotic and avascular villi and minimal lymphoplasmacytic villitis (HE staining, ×100).