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A Case of Congenital Syphilis Presenting with Unusual Skin Eruptions
Alexander K C Leung1, Kin Fon Leong2, Joseph M Lam3
1Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada T2M 0H5.
Insights
Congenital syphilis is increasing in developed nations, posing diagnostic challenges due to varied infant presentations. This case highlights rare skin findings, including keratoderma and nail abnormalities, crucial for early diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Congenital syphilis incidence is rising in developed countries.
- Diagnosis is challenging due to asymptomatic infants and nonspecific symptoms.
- Diverse and atypical presentations require clinical familiarity.
Observation:
- A 2-week-old male infant presented with congenital syphilis.
- Cutaneous manifestations included diffuse erythematous keratoderma with desquamation and fissures on hands and feet.
- Additional findings were perioral fissures and onychauxis of fingernails and toenails.
Findings:
- The infant exhibited diffuse, erythematous keratoderma of the hands and feet.
- Thickened nails (onychauxis) were observed.
- These specific dermatological findings are novel in reported congenital syphilis cases.
Implications:
- Increased awareness of diverse congenital syphilis presentations is vital for timely diagnosis.
- Early diagnosis and treatment are crucial to prevent long-term infant morbidity.
- This case expands the spectrum of recognized cutaneous manifestations of congenital syphilis.
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.
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