Baby Rash on Hands and Feet, Congenital Infectino

Korean J Pediatr. 2011 Dec; 54(12): 512–514.

Early congenital syphilis presenting with skin eruption lone: a instance report

Hak Immature Kim, Medico,¹ Beom Joon Kim, Doc, PhD,^two Ji Hyun Kim, MD, PhD, ^{three, 4} and Byoung Hoon Yoo, MD, PhD^ane

Hak Young Kim

^oneDepartment of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea.

Beom Joon Kim

^twoDepartment of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.

Ji Hyun Kim

ⁱⁱⁱDepartment of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

⁴Environmental Wellness Center for Atopic Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Byoung Hoon Yoo

¹Department of Pediatrics, Chung-Ang University Higher of Medicine, Seoul, Korea.

Received 2011 Mar 25; Revised 2011 Jun 7; Accepted 2011 Jul sixteen.

Abstract

Congenital syphilis is one of the most well-known congenital infections, withal it remains a worldwide public health problem. Congenital syphilis can involve any organ system and present with diverse symptoms. Withal, early on diagnosis of congenital syphilis is hard because more than half of the affected infants are asymptomatic, and the signs in symptomatic infants may be subtle and nonspecific. Hither, we report a instance of built syphilis with merely a skin rash, which led to a delay in diagnosis. This case indicates that congenital syphilis should be considered throughout early babyhood.

Keywords: Congenital syphilis, Skin rash

Introduction

Built syphilis, acquired by Treponema pallidum is still a public health result worldwide, especially in developing countries1). Accordingly, it is important to exist familiar with its symptoms, which can be subtle and nonspecific2). Recently, an increase in the incidence and prevalence of early congenital syphilis was observed in Korea as well every bit other Western countries despite prenatal serologic screening and treatment programs which are included in the routine antenatal examination1,3). Therefore, physicians should exist enlightened of the diverse clinical features of syphilis to enable early on diagnosis of the disease. We report hither a instance of built syphilis in a 3-month-old infant who had whole trunk skin eruption and no other specific symptoms, which led to a delay in diagnosis. His mother was tested for the illness during the prenatal period and the test was negative; however, she tested positive for syphilis afterward.

Case report

A iii-month-old male child was admitted due to a three-calendar week history of an asymptomatic, widespread peel eruption. He was given the Diphtheria-Tetanus-acellular Pertussis (DTaP) vaccination 2 days prior to skin rash and his parents had taken him to several pediatric and dermatologic clinics, but could not identify his illness. He had been born to a 24-year-onetime, G1P1A0 mother who had adequate prenatal care at other clinics. She was tested for syphilis at 12 and 38 weeks of gestational age and was told that the tests were negative. The patient was delivered at 39⁺⁶ weeks of gestational age past normal spontaneous vaginal commitment and the birth weight was 3,270 g.

Upon physical examination, his superlative was 61.5 cm (25 to 50th percentile), weight was half dozen.5 kg (25 to 50th percentile), and head circumference was 39.5 cm (10 to 25th percentile). He ate only a small amount of milk and his activeness was decreased. His belly was soft and liver and spleen were not palpable. He had generalized erythematous, targetoid, scaly macules, papules, pustules (Fig. 1A) and desquamation at the hand and human foot (Fig. 1B).

Generalized erythematous, targetoid, scaly macules, papules, and pustules (A), and desquamation of the patient's paw (B).

Complete blood cell counts demonstrated normocytic normochromic anemia (hemoglobin 8.3 chiliad/dL and hematocrit 27.eight%) with leukocytosis (white blood cell [WBC] 20,000/mm³ with neutrophils 43%, lymphocytes 52%, monocytes 4%, eosinophils ane%) and thrombocytopenia (86,000/µL). His serum full protein was 4.ix g/dL with an albumin level of 2.7 thou/dL. Result of liver office tests were normal with aspartate aminotransferase activity 47 IU/L, alanine aminotransferase activity 18 IU/L, and total bilirubin 0.4 mg/dL, with a straight bilirubin of 0.2 mg/dL. Serum iron levels were normal and the results of a Coombs' examination were negative. Serologic tests for cytomegalovirus, Rubella, Herpes simplex virus and Toxoplasmosis were all negative.

His claret venereal illness research laboratory (VDRL) exam was positive in was positive in 1:32 dilutions and cerebrospinal fluid (CSF) VDRL analysis positive with 1:1 dilution. Laboratory studies of the CSF showed the following values: WBCs, 5/mm³; red blood cells, 40/mm³; protein, 26.3 mg/dL; glucose, 68 mg/dL, with a plasma glucose level of 156 mg/dL. As his non-treponemal examination for syphilis was positive, treponemal examination was washed. His syphilis serology test showed a positive fluorescent-treponemal antibody-captivated test immunoglobulin Thou as well equally T. pallidum hemagglutination assay test.

No organism was identified in whatsoever culture specimen, such as blood, urine or CSF. Although radiographic test of the infant'southward long bones showed diaphyseal periostitis (Fig. two), no aberration was detected on brain magnetic resonance imaging. And hearing test was normal. After we diagnosed his illness as built syphilis, his parents were tested for syphilis and the mother'southward VDRL was found to be reactive with 1:4 dilutions and the begetter's VDRL was found to be reactive with a i:1 dilution. Still this outcome, his mother had no specific symptoms. Based on these findings, the female parent'southward VDRL results during prenatal care were erroneous.

Radiographic test of the long bones demonstrated diaphyseal periostitis, indicating syphilitic changes.

We treated the patient with procaine penicillin Grand for 14 days. His skin eruption was resolved inside several days. After iv days of penicillin, results of serology exam returned to normal with platelet count of 235,000/µL, WBC count of xiii,670/mm³. During two weeks of hospitalization, the anemia slowly improved. Hemoglobin was increased to 10.0 g/dL with hematocrit 31.4%. Likewise, total protein was elevated slowly to 5.6 g/dL with albumin four g/dL. His parents were also treated with benzathine penicillin G. The patient was 5 calendar month olds at the last visit and his physical examination was normal, including neurologic examination. In add-on, the baby showed a reduction in seroreactivity from i:32 to 1:8 dilutions.

Give-and-take

This iii-month-one-time infant presented just with skin eruption, which led to difficulty in diagnosis. Several physicians could not establish what his illness was, and his symptoms were misinterpreted equally adverse reactions acquired past DTaP vaccination. In addition, the maternal self written report that she was VDRL-negative caused a farther filibuster in diagnosis of the patient. Diagnosis of early congenital syphilis is difficult because more than half of the infants are asymptomatic, and signs in symptomatic infants may exist subtle and nonspecific4). We found a report of an babe with a skin rash whose mother had acceptable prenatal care, like to our patient2). If diagnosis is missed, decease may result, despite the fact that syphilis is a very piece of cake and cheap affliction to treat5).

Congenital syphilis occurs when T. pallidum crosses the placenta from the mother to the fetus during pregnancy or past contact with an infectious lesion during birth6). Manifestations of congenital syphilis are divided into early and belatedly signs based on the kickoff 2 years of life. Mucocutaneous interest is present in as many as 70 percent of infants and may be credible at birth or develop during the kickoff few weeks of life6). Cutaneous findings of early built syphilis is classically a vesiculobullous or maculopapular rash on the palms and soles and may be associated with desquamation7). Other types of rashes such as erythema multiforme have as well been reported7,8). In add-on, symptoms of early congenital syphilis include fever, failure to thrive, hepatosplenomegaly, lymphadenopathy, osteochondritis, pneumonitis, and rhinitis6). Leukocytosis, Coombs-negative hemolytic anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, hyperbilirubinemia, and elevated liver enzyme levels may be present6,9). Considering these laboratory findings are hard to identify upon physical examination, a high alphabetize of suspicion is necessary to make the correct diagnosis early. Although acral dermatitis, vitamin or nutrient deficiency, and hand eczema might mimic this disorder, skin rash of early congenital syphilis is relatively recalcitrant to classical eczema treatment, which might exist differential diagnostic point10,11). Characteristic mucocutaneous rash, presenting with erythematous maculopapular or bullous lesions, followed past desquamation involving hands and feet, are common in built syphilis12).

For definitive diagnosis, the Centers for Disease Command (CDC) recommends identification of syphilis in the mother; lack of testify of adequate maternal treatment; presence of clinical, laboratory or radiological evidence of syphilis in the infant; and comparison of maternal and infant non-treponemal serologic titers using the aforementioned test and preferably the aforementioned laboratory, as was conducted in this case13). In addition, The CDC recommends serologic VDRL testing of pregnant women during the beginning prenatal visit and additional serologic testing and evaluation of sexual history at 28 weeks of gestation and soon later on commitment in communities in which at that place is a loftier risk of congenital syphilis13).

Congenital syphilis is a preventable and treatable disease if physicians are aware of its various clinical symptoms. Therefore, clinical suspicion and formal confirmation of antenatal screening results also every bit a detailed maternal history provide important clues for the diagnosis of built syphilis.

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Baby Rash on Hands and Feet, Congenital Infectino

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3274658/

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