|Year : 2008 | Volume
| Issue : 1 | Page : 32-33
Late congenital syphilis with stigmata
Megha Modi1, Archana Sharma1, Yogesh S Marfatia2, Eknath Naik2, John Toney2
1 Department of Skin, V. D. Medical College and S.S.G. Hospital, Vadodara, Gujarat, India,
2 Division of Infectious Diseases and International Medicine, University of South Florida, Tampa, USA,
Yogesh S Marfatia
OPD-1, Department of Skin and V. D. Medical College, Vadodara, India
| Abstract|| |
Congenital syphilis is a rare entity and is an indicator of sexually transmitted diseases in a given population. We are reporting a case of late congenital syphilis presenting with palatal perforation at an age of 13 years.
Keywords: Congenital syphilis, palatal perforation
|How to cite this article:|
Modi M, Sharma A, Marfatia YS, Naik E, Toney J. Late congenital syphilis with stigmata. Indian J Sex Transm Dis 2008;29:32-3
|How to cite this URL:|
Modi M, Sharma A, Marfatia YS, Naik E, Toney J. Late congenital syphilis with stigmata. Indian J Sex Transm Dis [serial online] 2008 [cited 2014 Mar 16];29:32-3. Available from: http://www.ijstd.org/text.asp?2008/29/1/32/42713
| Introduction|| |
Congenital syphilis is transmitted transplacentally from an infected mother to her fetus. Its occurrence is one of the indicators of STDs in a given population. The control of congenital syphilis depends on adequate screening and treatment being given to the infected pregnant woman at the earliest opportunity.
Congenital syphilis has been classified into early congenital syphilis, late congenital syphilis, and the stigmata.  Late congenital syphilis refers to the diagnosis of syphilis in individuals from 2-30 years of age, where the primary infection was acquired perinatally.  Common characteristics of late congenital syphilis include Hutchinson's triad (Hutchinson's teeth,  interstitial keratitis, and eighth nerve deafness), bone changes such as frontal bossing, saddle nose deformity, "sabre shins" or anteriorly bowed tibia, and perforation of the hard palate.
We report a case of late congenital syphilis to emphasize that congenital syphilis still occurs and global antenatal screening is mandatory to prevent this serious but preventable disease.
| Case Report|| |
A 13-year-old female was referred to us from the ENT department of our hospital for palatal perforation with difficulty in eating and nasal speech. On examination, there was a perforation of about 1.5 cm diameter involving the hard palate [Figure 1]. Her incisors were peg shaped (suggestive of Hutchinson's teeth) and her nasal bridge was depressed consistent with a "saddle nose" nasal deformity [Figure 2]. Scars suggestive of gummata were present on her cheeks [Figure 1] and [Figure 2]. There was no lymphadenopathy. There was no history or signs suggestive of sexual abuse. These findings suggested the diagnosis of late congenital syphilis. Venereal disease research laboratory (VDRL) testing from the young patient returned reactive at 1:16 dilutions and Treponema pallidum magglutination assay (TPHA) was positive confirming the diagnosis of prior exposure to syphilis. She was nonreactive for HIV. Slit lamp examination, fundoscopy, and tests for nerve deafness were without abnormality. X-ray of both legs revealed irregular periosteum and cortex at the anterior and medial margins of midshaft tibia. Chest X-ray, USG abdomen, and other routine laboratory investigations were normal. Patient refused the cerebrospinal fluid (CSF) examination.
Her parents had no overt signs of syphilis. They were tested for syphilis and were weakly reactive for VDRL, but TPHA was positive. There was no history of abortion(s) in mother and the only younger sibling had no features of congenital syphilis and was VDRL nonreactive. The girl was treated with benzathine penicillin injection 50,000 U/kg intramuscularly. There was a fall in titer of VDRL after three months from her first visit. Her parents were also treated with benzathine penicillin injection.
| Discussion|| |
Late congenital syphilis is a rare entity. This case presented to us due to the palatal perforation. Differential diagnosis of a lesion presenting as palatal perforation should include tertiary syphilis, leprosy, tuberculosis, mucormycosis, mechanical trauma, intranasal cocaine abuse, malignancies, Wegener's granulomatosis, sarcoidosis, and midline nonhealing granuloma.  A positive VDRL and TPHA along with other clinical features helped us to arrive at the diagnosis of late congenital syphilis. Chaudhary et al. had reported a similar case of late congenital syphilis.  Sood et al. reported a case of stigmata in a 70-year-old male. 
This case presents a 13-year-old person, suggesting antenatal care was either not available or was not accessed by the mother. Also, the child did not receive proper healthcare for such a long period. Both the children were delivered at home without any antenatal healthcare. The parents were seropositive for syphilis with weakly reactive VDRL testing suggests that they had also not taken appropriate treatment and weak positivity may be due to antibiotics taken for some other cause.
| Conclusion|| |
Congenital syphilis is seen rarely these days due to screening of all pregnant women with VDRL test, but even a single case points toward lacunae in our healthcare facilities. Even though the facilities are available, those in extreme need are not able to access them.
| References|| |
|1.||Singh OP. Congenital syphilis. In: Sharma VK, editors. Sexually transmitted diseases and AIDS, 1 st ed. New Delhi: Viva Books Private Limited; 2003. p. 183. |
|2.||Shah AM, Boby KF, Karande SC, Lahiri KR, Jain MK. Late onset congenital syphilis. Indian Pediatr 1995;32:795-8. [PUBMED] |
|3.||Hutchinson J. Report on the effects of infantile syphilis in marring the development of the teeth. Trans Pathol Soc London 1858;9:449-56. |
|4.||Chaudhary M, Kashyap B, Bhalla P. Congenital syphilis, still a reality in 21 st century: A case report. J Med Case Reports 2007;1:90. [PUBMED] [FULLTEXT]|
|5.||Sood VK, Dogra A, Minocha YC. Congenital syphilis-stigmata. Indian J Dermatol Venerol Leprol 1995;61:358-9. |
[Figure 1], [Figure 2]