Congenital syphilis, still a reality
A three month old female child weighing 2 kg normally delivered at term presented with lesions all over the body with oro-genital erosions since 1½ month.\nOn examination, there were severe desquamating erythematous papulosquamous lesions over face, upper extremities, trunk, buttocks and legs. Multiple superficial erosions were present on palm, soles, genitals, buttocks and natal cleft [Figures –]. Moist erosive lesion with bleeding and crusting were present around oral cavity and nostrils. She had high arched palate without perforation which enables her to suck properly []. Syphilitic snuffles and rhagades were present. Epitrochlear and inguinal lymph nodes were enlarged and rubbery in consistency. Patient had moderate hepatosplenomegaly without cardiac, bone or joint involvement. X-ray of skull and long bones showed no abnormality. Ophthalmic examination including fundoscopy was normal.\nOn history, it was found that the baby was delivered at home and the mother had not taken any antenatal visits. Mother had a history of lesion over the genital area twice in the past i.e., two years and six month prior to the birth of the patient for which she has taken some treatment from local doctor. The records of the above-mentioned condition or any treatment taken were not available. She is second gravida with h/o of single second trimester abortion during last pregnancy. Father of the baby did not have any history of any sexually transmitted diseases (STDs) but had an h/o unprotected premarital exposure. Her parents had no overt signs of syphilis. Venereal disease research laboratory (VDRL) with dilution of patient was 1:512 while that of parents were 1:64. Parents as well as baby were non-reactive for HIV. Presumptive diagnosis of congenital syphilis was made based on four fold raise in patient titre. Parents were given benzathine penicillin G 2.4 MU, i.m. in single dose and patient was treated successfully with 1.5 lakh U/day i.m. Procaine penicillin G for 10 days.