Mucocutaneous and musculoskeletal manifestation as an early symptomatic congenital syphilis: A rare case

Abstract

Background: Congenital syphilis (CS) is attributable to the transmission of Treponema pallidum from the mother to the fetus transplacental during gestation. The incidence rate of congenital syphilis is 15 per 100,000 newborns by 2020. Mucocutaneous involvement is present in as many as 70% of infants and may be apparent at birth or develop during the first few weeks of life. Cutaneous findings of early CS classically a vesiculobullous or maculopapular rash on the palms and soles may be associated with desquamation. Skeletal manifestations of congenital syphilis occur in 60%-80% of infants, including osteitis (0.7%), metaphysitis (24%), and periosteal reaction (34%). It is important to be fully informed regarding the early diagnosis and treatment of congenital syphilis to prevent its devastating complications to death. This case report describes clinical features, treatment, and prognosis of congenital syphilis presented with mucocutaneous lesions and musculoskeletal manifestations. Case representation: A one-day-old boy preterm infant, 2145 grams, born spontaneously, presented with ruptured bullous lesions and desquamation on the feet and hands. The laboratory revealed thrombocytopenia, elevated C-reactive protein, elevated bilirubin total (10.9 mg/dL) and direct bilirubin (6.21 mg/dL) at 24 days old, indicating an intrahepatic cholestasis caused by syphilis. Serum VDRL 1:128 and TPHA >1:5120. Long bone radiology showed periostitis involving the humerus, ulna, radius dextra and sinistra, femur dextra and sinistra, a feature of congenital syphilis. The patient was treated with procaine penicillin 107,000 international units intravenous every 24 hours for 10 days. Conclusion: The early recognition of mucocutaneous and musculoskeletal involvement as an early manifestation of CS improved with procaine penicillin intravenous for 10 days.