Congenital syphilis, the great imitator. Case Report

Syphilis is a sexually transmitted infection; it is caused by Treponema pallidum and transmitted by the transplacental to neonate, of a mother with syphilis during pregnancy in 70-90% of cases. One clinical expression is dermatological lesions that appear in 60% of cases; and it should generate neonatal death by 40%. A minor nursling with skin lesions of 30 days evolution includes generalized puncture, non-ulcerated lesions and necrotic lesions in distal regions, despite antibiotic therapy, clinical deterioration progresses until his death. Serological studies confirm the diagnosis of congenital syphilis. Additionally, it presents a prenatal maternal history of hyperkeratinizing lesions on the skin of the hands and feet in the seventh month of gestation, which improve with ketoconazole furthermore with a treponemic test (VDRL) negative in maternal serum. Congenital syphilis is a controversial disease, since in 60% of cases they are asymptomatic at birth and the clinic appears during the first 3 months of life. Frequently the maternal history of syphilis is known, either by clinic or by prenatal scrutiny through non-treponemic tests such as VDRL, however the mother may be asymptomatic or she have not clear symptoms of this disease. Dermatological lesions are a frequent symptom, but this case presents an unusual evolution. Spotlight the importance of prenatal scrutiny, through serological and ultrasound studies, also it is recommended that neonates who are children of mothers exposed to risk, screening by serological tests should be performed and if accompanied by skin lesions the diagnostic of congenital syphilis should be considered.