日本未熟児新生児学会雑誌　第19巻　第1号　87～91頁（2007年）

日本未熟児新生児学会雑誌　19(1)：87-91；2007　

受付日：平成17．02．01

受理日：平成18．05．23

Jarisch-Herxheimer反応により重篤な循環不全に陥った新生児先天梅毒の一例

Jarisch-Herxheimer Reaction Occurring During Treatment of a Neonate Suffering from Congenital Syphilis

大分県立病院　新生児科

Department of Neonatology，Oita Prefectural Hospital

久保鋭治・園田和孝・井上和彦・飯田浩一

Eiji KUBO，Kazutaka SONODA，Kazuhiko INOUE，Kouichi IIDA

Key Words：congenital syphilis・Jarisch-Herxheimer reaction・pneumonitis・KL-6

　母親は妊婦健診未受診で前期破水あり，経膣分娩で児は出生。児は推定在胎31週1日，出生体重1,388gの極低出生体重児で，重症新生児仮死があり入院時より集中治療を要した。特徴的な皮膚病変，肝腫大，間質性肺炎があり母児の血清の梅毒抗体検査の結果より先天梅毒と診断した。抗生剤初回投与5時間後より体温上昇，血圧低下し急激に全身状態が増悪した。その原因として新生児期としては比較的稀なJarisch-Herxheimer反応が考えられた。新生児期においても梅毒治療の経過中，抗生剤初回投与後に急激に全身状態が増悪することがあり得るため慎重な経過観察が必要と思われた。

　We report a female infant suffering from congenital syphilis with associated pneumonitis and a persistent pulmonary hypertension of the newborn（PPHN）－like condition. Her mother had premature rupture of membranes and presented to our hospital on the day of delivery in active labour. The baby was estimated at 31 weeks of gestation and weight was 1388g. She had severe asphyxia and required intensive care. She had rashes on her palms and soles, hepatomegaly and pneumonitis, all compatible with congenital syphilis. A rapid plasma reagin test of the infant and her mother were reactive, and the baby’s fluorescent treponemal antibody absorption IgM was positive；therefore, we diagnosed congenital syphilis. She also appeared to have‘Jarisch-Herxheimer reaction’, which is rare in the neonatal period, five hours after the first administration of antibiotics and consequently induced the PPHN-like condition. Careful observation should be made after the first administration of antibiotics in the treatment of congenital syphilis, even in the neonatal period.