Early congenital syphilis

Case 1 A boy was delivered at 35 weeks' gestation by standard vaginal delivery. His mother was a 24‐year‐old gravida 4, para 1 woman. Purple erythematous macules and diffuse vesicular eruptions of various sizes were found extensively over the skin. The rapid plasma reagin (RPR) titer test of the newborn showed 1 : 16 positive and 1 : 32 weakly positive. There was no obvious history of maternal or paternal syphilitic infection; however, the mother confessed to having sexual contact with other men, and had a history of extrauterine pregnancy and spontaneous abortion. She showed a 1 : 8 positive and 1 : 16 weakly positive RPR titer test. The father's RPR titer was 1 : 8 positive and Treponema pallidum hemagglutination (TPHA) test was 1 : 160 positive. Physical examination revealed that this 2300‐g boy had a rapid respiration of 55/min. The Apgar score was eight at 1 min. The boy's temperature was 36 °C. He had a normal skull, and the size of the bregma was 1.2 cm × 1.2 cm. The intranasal septum was normal with excessive excretions in the nostrils. The lips were slightly red. His intraoral mucous membrane was smooth, and his pharynx and throat were normal. His respiratory movement was symmetrical. He had sinus rhythm (135 b.p.m.) and no signs of abnormality. His breathing sound was clear with signs of effusion. The abdominal examination revealed hepatosplenomegaly. There was no transudate from the umbilicus. The liver was palpable 2 cm below the costal margin. The spleen was also palpable just below the costal margin. The movement of the boy's limbs was normal. The fingernails had developed to the end of the fingers. The pleat drape of the metatarsal was less than one‐third of the foot area. The boy had normal neural reflexes including rooting, sucking, and Moro reflex. Examination of the skin revealed a light purple color all over the body, with diffuse reddish‐copper maculopapules, over which there were pale vesicles about 0.5‐1.2 cm in size. Part of the vesicular eruption that occurred especially on the palms and soles had ruptured (Figs 1‐6). The majority of the body surface was involved, but mucosal involvement was not noted. 1 Reddish‐copper maculopapules with pale vesicles especially on the extremities 2 Eruption on the face with ruptured vesicles 3 Vesicles on the soles and ruptured vesicle on the toe 4 Maculopapules and vesicles on the instep 5 Vesicles on the back of the hand with denuded area 6 Erythematous macules around vesicle on the buttock Labo