Colestase associada à sífilis congênita: análise de casos de pacientes de 0 a 3 meses de idade internados em hospital universitário na Bahia no ano de 2024

Abstract

Introduction: Neonatal cholestasis is a condition characterized by reduced bile flow during the first months of life and represents a diagnostic emergency in pediatrics. Among its multiple etiologies, congenital syphilis stands out as a vertically transmitted infection capable of causing significant hepatic involvement and systemic manifestations. Association with other congenital infections may worsen hepatobiliary dysfunction and prolong the clinical course. Early diagnosis and timely treatment are essential to prevent hepatic complications and reduce neonatal morbidity and mortality. Methods: This is an observational, descriptive, retrospective cohort study based on data obtained from medical record review of patients aged 0 to 3 months with a confirmed diagnosis of congenital syphilis and associated hepatic involvement (cholestasis), who were hospitalized at a university hospital in the state of Bahia, Brazil, in 2024. Results: The sample consisted of eight patients, with a predominance of males (75%), whose clinical and laboratory manifestations of cholestasis occurred early, within the first 15 days of life. Jaundice was the most frequent clinical finding, associated with elevated transaminases, bilirubin levels, and alkaline phosphatase. Time to resolution ranged from 2 to 5 months and was longer in cases associated with neurosyphilis, hypothyroidism, infections, or prematurity. Only one patient required invasive investigation due to persistent acholic stools. Discussion/Conclusions: A predominance of males and variable clinical presentation were observed, with jaundice as the main finding, not always accompanied by classic signs of obstructive cholestasis. The laboratory profile showed a mixed biochemical pattern, often associated with infections and concomitant conditions such as hypothyroidism and neurosyphilis. Overall evolution was favorable, with gradual resolution within five months and low need for invasive procedures. These findings reinforce the multifactorial nature of neonatal cholestasis and the importance of a comprehensive, conservative, and individualized diagnostic approach.