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Indian Pediatrics 2002; 39:972-973

Congenital Syphilis


A term SGA baby boy with failure to thrive presented at two and a half months of age with skin lesions of 2 weeks duration and diarrhea for one week. On examination, the baby had copious rhinitis with excoriation and crusted lesions around the nasal vestibule (Fig. 1). He also had erythematous lesions with desquamation on the palms, soles, perianal and scrotal regions. The baby was irritable but there was no evidence of pseudoparalysis. The hair and nails were normal. There was no hepatosplenomegaly. Rest of clinical examination was normal. Both mother and father did not give any history of genital lesions, and their clinical examination was normal.

Fig. 1. Crusted lesions around the nose and erythematous desquamation on palms, soles and perianal and scrotal region.

Differential diagnoses of congenital syphilis and acrodermatitis enteropathica were considered at admission. Skeletal survey showed mataphysitis and osteochondritis of both proximal femora, more pronounced on the left side; and periostitis of long bones (Fig. 2). Serum VDRL was reactive in 1:4 dilutions in the baby, mother and, father, but TPHA was positive in all of them. The baby was treated with intravenous aqueous penicillin G in a dose of 1,00,000 units/kg/day for 14 days. The lesions healed and he became asymptomatic in 2-3 weeks. Both parents were given three doses of 2.4 MU of Benzathine penicillin.

Fig. 2. Osteochondritis and metaphysitis of femora and periostitis of tibia and femur.

Syphilis during pregnancy has a transmission rate approaching 100%. "Snuffles"- the characteristic mucopurulent or bloody copious rhinitis - is an early and distinctive manifestation of congenital syphilis. Mucocutaneous rash, osteochon-dritis, and periostitis which this infant had are commonly seen. Acrodermatitis enteropathica also presents with failure to thrive, similar type of skin lesions and diarrhea. But in addition they also have a peculiar reddish tinted hair, alopecia and ocular manifestations, which this baby didnít have. Bone lesions are also not seen in acrodermatitis enteropathica.

Sudheer M.S.,

M.P. Silveira,

Goa Medical College, Bambolim,

Goa 403 202, India.

E-mail: drsudheerms@yahoo.com


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