A newborn presents on day 2 of life with a pemphigus-like bullous eruption involving the palms and soles, hepatosplenomegaly, and snuffles (seropurulent nasal discharge). The mother had untreated syphilis throughout pregnancy. Serology: baby's IgM-TPHA positive. What is this condition and the treatment?
- A Early congenital syphilis; aqueous penicillin G 50,000 units/kg/dose IV 12-hourly (first 7 days) then 8-hourly for total 10 days ✓
- B Congenital herpes simplex; acyclovir IV for 21 days
- C Neonatal pemphigus vulgaris; systemic steroids
- D Late congenital syphilis; benzathine penicillin G 50,000 units/kg IM single dose
Explanation
Congenital syphilis presenting within the first 2 years of life is classified as early congenital syphilis. Characteristic findings in neonates include syphilitic pemphigus (bullous lesions on palms and soles — the ONLY form of syphilis with bullous lesions), snuffles (copious nasal discharge teeming with spirochaetes — highly infectious), hepatosplenomegaly, osteochondritis (Wegner's sign on X-ray), and anaemia. Positive IgM treponemal antibody confirms active neonatal infection (IgM does not cross the placenta). Treatment is aqueous crystalline penicillin G IV for 10 days per current CDC/IADVL recommendations.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.