Early congenital syphilis in a premature newborn: typical cutaneous manifestations in atypical skin areas

Abstract

Images in neonatal medicine Images in neonatal medicineEarly congenital syphilis in a premature newborn: typical cutaneous manifestations in atypical skin areasThe illustrated infant was birthed by an emergency caesarean section owing to placental abruption at 35 weeks of gestational age. The mother was serologically negative for relevant infections, except for a weakly-reactive Venereal Disease Research Laboratory (VDRL) test at the time of delivery.Examination of the newborn revealed multiple widespread vesicular bullous eruption involving the back of hands and feet, some of which were already broken leaving a denuded and macerated area (fi gure 1). Also found were annular maculopapular lesions on the anterior surface of the thorax and abdomen, hepatosplenomegaly with elevated direct bilirubin, anaemia and leukaemoid blood picture.Haematology revealed serum positive for enzyme immunoassay for treponemal immunoglobulin M, Treponema Pallidum Haemagglutination (1/5120) and VDRL (1/64). The cerebrospinal fl uid VDRL test was negative.A diagnosis of early congenital syphilis was made and was treated with parenteral penicillin G. The newborn showed improvement in the clinical conditions following treatment until discharge.Manifestations of congenital syphilis vary from asymptomatic infection to stillbirth. 1 Mucocutaneous manifestations occur in 15-60% of infected infants. 2 In this case there was the typical early pemphigus syphiliticus, usually affecting palms and soles, 2-4 involving atypical skin areas whereby highlighting how varied and severe the signs of congenital syphilis can be, and the consequent need for the doctors to be aware of this condition since an early and appropriate treatment can produce a good outcome. 5 REFERENCES1. Khetarpal S, Kempf E, Mostow E. Congenital syphilis: early-and late-stage fi ndings of rhagades and dental anomalies. Pediatr Dermatol 2011;28:401-3. 2. Remington JS, Klein JO. Infectious disease of the fetus and newborn. Fifth edition. Philadelphia: WB Saunders 2001;12:643-81. 3. Liu CC, So WC, Lin CH, et al. Congenital syphilis: clinical manifestations in premature infants. Scand J Infect Dis 1993;25:741-5. 4. Chawla V, Pandit PB, Nkrumah FK. Congenital syphilis in the newborn. Arch Dis Child Fetal Neonatal Ed 2012;97:F471.

Congenital bullous syphilis in a newborn: A novel approach to diagnosis using immunohistochemical staining on a blister roof

“…6 As seen in our patient, congenital bullous syphilis is a rare presentation of early, symptomatic congenital syphilis that is characterized by eroded bullae that can desquamate. [7][8][9][10][11] Reported cases describe congenital bullous syphilis, previously termed pemphigus syphiliticus, as eroded bullae-like lesions on infants' palms and soles, but also include generalized presentations. [7][8][9][10][11][12] Our patient had other findings consistent with congenital syphilis including hepatosplenomegaly, anemia, jaundice, thrombocytopenia, osteitis, and neurosyphilis.…”

“…[7][8][9][10][11] Reported cases describe congenital bullous syphilis, previously termed pemphigus syphiliticus, as eroded bullae-like lesions on infants' palms and soles, but also include generalized presentations. [7][8][9][10][11][12] Our patient had other findings consistent with congenital syphilis including hepatosplenomegaly, anemia, jaundice, thrombocytopenia, osteitis, and neurosyphilis. 2 Other symptoms that might be seen in congenital syphilis, but are absent in our patient, include rhinitis (snuffles) with mucopurulent nasal discharge, chorioretinopathy, glaucoma, cataracts, interstitial keratitis, saddle nose, frontal bossing due to periostitis, tibial thickening (saber shins), joint swelling (Clutton joints), abnormal tooth development (Hutchinson's teeth, mulberry molars), interstitial keratitis, neurologic deafness, and optic atrophy.…”

“…2 All the reported cases on congenital bullous syphilis used serological testing to confirm the diagnosis of syphilis. [7][8][9][10][11][12] Three of the cases included additional diagnostic testing by biopsy of a skin lesion with subsequent treponemal IHC for the detection of T. pallidum spirochetes. 7,8,12 Kim et al reported the use of PCR for T. pallidum on purulent material to aid in diagnosis of congenital bullous syphilis.…”

A rare presentation of congenital syphilis: Pemphigus syphiliticus in a newborn infant with extensive desquamation of the extremities

“…Because the bullae are fragile and rapidly erode, denuded bullae and desquamation is the most likely clinical presentation, as in this case. In a PubMed search for “pemphigus syphiliticus,” “syphilis/syphilitic pemphigus,” “bullous syphilis,” “acral blister neonate,” and “congenital syphilis” filtering for Case Reports, fewer than 20 total other case reports of this bullous presentation were found since 1946, the beginning of PubMed indexing …”

“…In a PubMed search for "pemphigus syphiliticus," "syphilis/ syphilitic pemphigus," "bullous syphilis," "acral blister neonate," and "congenital syphilis" filtering for Case Reports, fewer than 20 total other case reports of this bullous presentation were found since 1946, the beginning of PubMed indexing. [7][8][9][10] In classic syphilography textbooks dating to 1869, the bullous presentation of congenital syphilis was regarded as common. 11,12 It was recognized in this era that, in adults, this blistering presentation "is almost always independent of syphilis," but in children, it "most frequently coexists with changes the syphilitic origin of which is indisputable."…”