Making a difference

The Office of Philanthropy established the Be the Difference award to honor an Upstate Prisma Health clinician and a leader who understand the impact of engagement and transformational giving. The 2022 award recipients are Robin LaCroix, MD, and Taylor Stathes, MS, CTRS, CCLS.

Dr. LaCroix, as medical director of Children’s Hospital–Upstate and an infectious disease expert, provided leadership and guidance throughout the COVID-19 pandemic. She gives countless hours to philanthropy, leading volunteer groups and councils, attending events, giving tours, meeting with community leaders, and ensuring that philanthropic funds for children are wellleveraged. She is an exemplar of someone who delivers compassionate, insightful care.

Stathes, Upstate manager of Children’s Hospital Child Life and Special Programs, ensures that child-friendly spaces exist at Children’s Hospital. She not only advocates for patients and families, but also works with community partners to help support our youngest patients. She knows well the power of philanthropy, as her programs are supported solely through philanthropic generosity.

Answer: C) Congenital syphilis

This patient presented with a constellation of findings to include rash, anemia, hepatomegaly and proteinuria in the face of a low serum albumin. The acute phase reactants indicated an inflammatory process. All bacterial cultures were negative; however, the serum RPR returned at 1:512.

In addition, the CSF fluid revealed a positive VDRL, indicating CNS disease. Other labs for congenital infection were negative. The patient was treated with 10 days of aqueous penicillin G.

Congenital syphilis has many associated findings to include bony defects and periostitis. Nephrotic syndrome and anemia, as in this case, are known complications. Later manifestations include snuffles, saddle nose and Hutchinson’s incisors.

During the hospitalization, a skeletal survey was obtained looking for Wimberger’s sign or sabre shins, radiologic classics of this disease. The X-rays were normal, indicating that more than likely this mother and baby were infected later in the pregnancy.

Timing of labs is always important in applying and interpreting results. On review, the mother’s negative prenatal labs were obtained in the first trimester.

Langerhan’s histiocytosis is a reasonable consideration, but the patient’s age, incidence of disease and type of rash limit this diagnosis. ARPD is not inflammatory.

References

AAP Committee on Infectious Diseases. The Red Book, 31st Edition, 773–88. Yun Hee Kim, Ji Ho Song, Chan Jong Kim and Eun Mi Yang.

Congenital syphilis presenting with only nephrotic syndrome: reemergence of a forgotten disease. J Korean Med Sci. 2017 Aug;32(8):1374–76.