A Case of Congenital Syphilis Presenting with Unusual Skin Eruptions

Abstract

Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis.

Congenital infections in Hong Kong: an overview of TORCH

“…9,36 Other manifestations of early congenital syphilis include non-immune hydrops fetalis, fever, pneumonia, secondary sepsis, myocarditis, inability to move an extremity because of pain ("pseudoparalysis of Parrot"), chorioretinitis, cataract, glaucoma, loss of eyebrows, uveitis, nephrotic syndrome, rectal bleeding from ileitis, malabsorption, keratoderma of the hands and feet, and onychauxis of the fingernails and toenails. [37][38][39] Laboratory abnormalities may include anaemia, thrombocytopenia, leukopenia, and leukocytosis. Radiological abnormalities may include erosions (osseous destruction) and lucencies (demineralisation) of the proximal medial tibial metaphysis (Wimberger sign), metaphyseal lucent bands, metaphyseal serrated appearance at the epiphyseal margin of long bones (Wegner sign), irregular areas of increased density and rarefaction ('moth-eaten' appearance), diaphyseal periostitis, and multiple sites of osteochondritis.…”

“…9 Manifestations include saddle nose; perioral fissures (rhagades); frontal bossing; Clutton joints (symmetrical, sterile, and painless synovial effusions); thickening of sternoclavicular joint (Higoumenakis sign); scaphoid scapula; anterior bowing of shins (saber shins); perforation of the hard palate; multicusped first molars (mulberry molars); peg-shaped, notched, widely spaced permanent upper central incisors (Hutchinson's teeth); interstitial keratitis; glaucoma; mental retardation; sensorineural deafness; and hydrocephalus. 9,36,37 Hutchinson's triad, including Hutchinson's teeth, interstitial keratitis, and sensorineural deafness, specific to late congenital syphilis, is rather rare. 36 Diagnosis of gestational syphilis can be established by serological tests, including both non-treponemal (rapid plasma regain [RPR] and venereal disease research laboratory [VDRL]) and treponemal tests (T pallidum particle agglutination and automated treponemal assay, eg enzyme immunoassay).…”

Penile warts: an update on their evaluation and management

“…Condylomata lata or condyloma latum are cutaneous lesions of secondary syphilis caused by the spirochete, Treponema pallidum 34,35. Clinically, condylomata lata manifest as moist, gray-white, velvety, flat-topped or cauliflower-like, broad papules or plaques 36.…”

Congenital syphilis-case report and review

“…Congenital syphilis can be subdivided into an early and late stage. The first stage is classified as clinical manifestations appearing within the first two years of life and commonly features hepatomegaly, a desquamating rash, hepatomegaly, and rhinitis; also, anemia, thrombocytopenia, peri-ostitis, and osteomyelitis have been documented [4] . 2/3 of infants are asymptomatic at birth and may not develop the clinical manifestations associated with syphilis for 3 to 8 weeks.…”

“…Also, congenital infections in the United States have been correlated with a lack of prenatal care which has been linked with racial and socioeconomic disparities, as well as with mental health disorders that go untreated, substance abuse disorders, and recent immigration to the United States [5] . Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists recommend routine testing at the first prenatal visit for all pregnant women, and in the second trimester and at delivery for high-risk women and those living in high prevalence areas [4] . We report an infant diagnosed with congenital syphilis with an unusual clinical presentation, whose mother did not have adequate prenatal care.…”