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Published on: September 20, 2018
Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review
Edoardo Cammarata1, Elia Esposto1, Nunzia Di Cristo1
1SCDU Dermatologia, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy.
Insights
Congenital bullous syphilis, a rare sign of congenital syphilis, presents with distinct skin lesions and aids early detection. Prompt diagnosis and penicillin treatment are vital for preventing severe outcomes and mortality in newborns.
Area of Science:
- Neonatology
- Dermatology
- Infectious Diseases
Background:
- Congenital syphilis poses a significant global health risk, potentially causing severe infant morbidity and mortality.
- Early detection of congenital syphilis is critical, and subtle signs like bullous lesions (congenital bullous syphilis or pemphigus syphiliticus) can be key indicators.
Purpose of the Study:
- To systematically review existing literature on congenital bullous syphilis.
- To analyze clinical patterns, diagnostic methods, treatment, and outcomes of this rare manifestation.
Main Methods:
- Systematic review of Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials.
- Inclusion of a newly documented case for comprehensive analysis.
- Extraction of demographic, clinical, laboratory, radiological, treatment, and outcome data.
Main Results:
- Twenty-four cases of congenital syphilis with bullous lesions were identified; twenty were analyzed.
- Three distinct clinical patterns of bullous lesions were observed: palmoplantar, acral, and diffuse bullous-erosive.
- Intravenous penicillin G was the primary treatment, with most infants achieving remission, though severe respiratory involvement correlated with mortality.
Conclusions:
- Bullous syphilis serves as a crucial early indicator of congenital syphilis, necessitating prompt recognition and diagnosis.
- Effective management relies on maternal screening, neonatal testing, clinical examination, and timely penicillin therapy.
- Heightened clinical vigilance and adherence to screening guidelines are essential for improving neonatal outcomes and preventing severe complications or death.
Abstract:
Background and Objectives: Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs-including bullous lesions (congenital bullous syphilis, also known as pemphigus syphiliticus)-may facilitate early detection. Recognizing this rare manifestation is crucial for timely intervention, reducing serious outcomes. Materials and Methods: We systematically reviewed Medline (PubMed), Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2024 for cases of congenital bullous syphilis, also known as pemphigus syphiliticus. We extracted demographic, clinical, laboratory, radiological, treatment, and outcome data. Additionally, we included clinical information from a newly documented case of congenital bullous syphilis managed in our center. Results: Twenty-four cases of congenital syphilis with bullous lesions were identified, twenty with sufficient detail for analysis. Patients presented three distinct clinical patterns: confined palmoplantar lesions, acrally distributed lesions, and diffuse bullous-erosive involvement. Despite variable severity, cutaneous manifestations provided a key diagnostic clue. Nontreponemal and treponemal serologic tests were central to diagnosis, supported by maternal screening and imaging. Intravenous penicillin G was the most frequently employed therapy. While most infants achieved remission, severe respiratory involvement was associated with mortality. Our new case aligned with these findings, demonstrating full resolution after appropriate antibiotic therapy. Conclusions: Bullous syphilis, though rare, is an important early sign of congenital syphilis. Prompt recognition and diagnosis-enabled by diligent maternal screening, targeted neonatal testing, and careful clinical examination-are essential to initiate timely penicillin therapy and prevent severe complications or death. This review underscores the need for heightened clinical vigilance and adherence to established guidelines for syphilis screening and treatment during pregnancy, ultimately improving neonatal outcomes.
