Disseminated congenital syphilis: a case report

Abstract

A 66-hour-old male neonate presented with generalized slight skin xanthochromia and scattered erythematous skin eruptions that faded with pressure. Serological testing revealed a positive Treponema pallidum agglutination (TPPA) test and positive anti-Treponema pallidum IgM antibodies. The patient was diagnosed as congenital syphilis. Neither the results of lumbar puncture and cerebrospinal fluid analysis nor those of X-ray examination of limb long bones supported the diagnosis of neurosyphilis or osseous syphilis. The patient presented with bloody stools and recurrent fever after regular treatment with aqueous penicillin for 14 days. Changes of antibiotics resulted in no improvement. Finally, the patient died of disseminated intravascular coagulation (DIC) and multi-organ functional impairment. Autopsy examination revealed inflammatory pathological changes caused by syphilitic infection in multiple organs and tissues, with gumma (gummatous syphilis) and polyangitis as the main pathological changes. Treponema pallidum was detected in liver and lung tissues by silver staining. His mother was found to be positive for anti-Treponema pallidum antibodies in the fourth month of pregnancy, but received no regular treatment with penicillin. Key words: Syphilis, congenital; Newborn; Penicillins; Autopsy