Type II Sacrococcygeal Teratoma in Newborn: Infection in the Postoperative Period

Introduction Sacrococcygeal teratoma (SCT) is classified into four types based on tumor location. The most common types are Type I (predominantly external with minimal internal extension) and Type II (similar internal and external components)[1]. Approximately 25–50% of cases are detected prenatally via ultrasonography (USG). Standard treatment is surgical resection, with rare wound infections [2,3]. Case Presentation A newborn was delivered at 38 weeks via a planned Cesarean section (IV pregnancy, II delivery). The congenital anomaly of SCT was suspected at 13 gestation weeks based on USG and MRI. Postnatally, a 9.6 × 9.2 × 7.0 cm mass was observed in the sacrococcygeal region. The MRI confirmed the diagnosis of type II SCT with presacral and intrapelvic extension. The newborn was evaluated by a pediatric oncologist and a surgeon, who recommended radical resection. The mass was surgically removed. The infant was transferred to the neonatal intensive care unit, where cefazolin and metronidazole were initiated prophylactically, fentanyl infusion was administered for pain management and mechanical ventilation was utilized. On postoperative day 5, the surgical wound developed and it was decided to perform wound revision surgery. After the procedure the patient developed a fever, laboratory indicated Escherichia Coli growth and treatment was changed to meropenem. Following extubation, the infant exhibited stridor and increased respiratory effort. A neurosonogram revealed N. striatum vasculopathy. Testing for TORCH infections detected 1645 IU/mL of cytomegalovirus (CMV) DNA copies. As congenital infection couldn't be ruled out, valganciclovir was initiated. The 29-day-old patient was discharged for outpatient care under the primary care physician. Discussion SCT is a rare germ cell tumor with an estimated incidence of 1/35,000–40,000 live births [1,2,5]. The etiology remains unknown and there is no established association between SCT and CMV [4]. Conclusions The prognosis of SCT depends on diagnosis timing, complications, and surgery severity, with low mortality and ~20% long-term functional impairment [3,5,6].