Early congenital syphilis: missed opportunities in a mother owing to many problems during pregnancy – a case report

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

“…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 7–11 . 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 7–12 .…”

“…7 Other cases confirmed the diagnosis based on the infant's clinical examination, T. pallidum hemagglutination test, RPR, and family history. [9][10][11] The most concerning diagnosis for our patient was SSSS, a Staphylococcus aureus infection that causes a hematogenously spread, toxin-mediated cutaneous eruption. The technique of using a blister roof lesion for pathology staining has been described before for use in SSSS diagnosis.…”

“…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.…”