Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review
<i>Background and Objectives:</i> Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs—including bullous lesions (congenital bullous syp...
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2025-01-01
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| author | Edoardo Cammarata Elia Esposto Nunzia Di Cristo Chiara Airoldi Elena Bernascone Valentina Burzio Paola Savoia |
| author_facet | Edoardo Cammarata Elia Esposto Nunzia Di Cristo Chiara Airoldi Elena Bernascone Valentina Burzio Paola Savoia |
| author_sort | Edoardo Cammarata |
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| description | <i>Background and Objectives:</i> Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs—including bullous lesions (congenital bullous syphilis, also known as pemphigus syphiliticus)—may facilitate early detection. Recognizing this rare manifestation is crucial for timely intervention, reducing serious outcomes. <i>Materials and Methods:</i> We systematically reviewed Medline (PubMed), Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2024 for cases of congenital bullous syphilis, also known as pemphigus syphiliticus. We extracted demographic, clinical, laboratory, radiological, treatment, and outcome data. Additionally, we included clinical information from a newly documented case of congenital bullous syphilis managed in our center. <i>Results</i>: Twenty-four cases of congenital syphilis with bullous lesions were identified, twenty with sufficient detail for analysis. Patients presented three distinct clinical patterns: confined palmoplantar lesions, acrally distributed lesions, and diffuse bullous-erosive involvement. Despite variable severity, cutaneous manifestations provided a key diagnostic clue. Nontreponemal and treponemal serologic tests were central to diagnosis, supported by maternal screening and imaging. Intravenous penicillin G was the most frequently employed therapy. While most infants achieved remission, severe respiratory involvement was associated with mortality. Our new case aligned with these findings, demonstrating full resolution after appropriate antibiotic therapy. <i>Conclusions:</i> Bullous syphilis, though rare, is an important early sign of congenital syphilis. Prompt recognition and diagnosis—enabled by diligent maternal screening, targeted neonatal testing, and careful clinical examination—are essential to initiate timely penicillin therapy and prevent severe complications or death. This review underscores the need for heightened clinical vigilance and adherence to established guidelines for syphilis screening and treatment during pregnancy, ultimately improving neonatal outcomes. |
| format | Article |
| id | doaj-art-dce3d5582c124bef964333c6a0b34fae |
| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj-art-dce3d5582c124bef964333c6a0b34fae2025-01-24T13:40:54ZengMDPI AGMedicina1010-660X1648-91442025-01-0161115810.3390/medicina61010158Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature ReviewEdoardo Cammarata0Elia Esposto1Nunzia Di Cristo2Chiara Airoldi3Elena Bernascone4Valentina Burzio5Paola Savoia6SCDU Dermatologia, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, ItalySCDU Dermatologia, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, ItalySCDU Dermatologia, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, ItalyDepartment of Translational Medicine, University of Eastern Piedmont, 28100 Novara, ItalyPediatric and Neonatal Intesive Care Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, ItalyPediatric and Neonatal Intesive Care Unit, Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, ItalyDepartment of Health Science, University of Eastern Piedmont, 28100 Novara, Italy<i>Background and Objectives:</i> Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs—including bullous lesions (congenital bullous syphilis, also known as pemphigus syphiliticus)—may facilitate early detection. Recognizing this rare manifestation is crucial for timely intervention, reducing serious outcomes. <i>Materials and Methods:</i> We systematically reviewed Medline (PubMed), Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2024 for cases of congenital bullous syphilis, also known as pemphigus syphiliticus. We extracted demographic, clinical, laboratory, radiological, treatment, and outcome data. Additionally, we included clinical information from a newly documented case of congenital bullous syphilis managed in our center. <i>Results</i>: Twenty-four cases of congenital syphilis with bullous lesions were identified, twenty with sufficient detail for analysis. Patients presented three distinct clinical patterns: confined palmoplantar lesions, acrally distributed lesions, and diffuse bullous-erosive involvement. Despite variable severity, cutaneous manifestations provided a key diagnostic clue. Nontreponemal and treponemal serologic tests were central to diagnosis, supported by maternal screening and imaging. Intravenous penicillin G was the most frequently employed therapy. While most infants achieved remission, severe respiratory involvement was associated with mortality. Our new case aligned with these findings, demonstrating full resolution after appropriate antibiotic therapy. <i>Conclusions:</i> Bullous syphilis, though rare, is an important early sign of congenital syphilis. Prompt recognition and diagnosis—enabled by diligent maternal screening, targeted neonatal testing, and careful clinical examination—are essential to initiate timely penicillin therapy and prevent severe complications or death. This review underscores the need for heightened clinical vigilance and adherence to established guidelines for syphilis screening and treatment during pregnancy, ultimately improving neonatal outcomes.https://www.mdpi.com/1648-9144/61/1/158congenital bullous syphilispemphigus syphiliticussecondary syphilisbullous lesionsdermatological manifestationsdifferential diagnosis |
| spellingShingle | Edoardo Cammarata Elia Esposto Nunzia Di Cristo Chiara Airoldi Elena Bernascone Valentina Burzio Paola Savoia Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review Medicina congenital bullous syphilis pemphigus syphiliticus secondary syphilis bullous lesions dermatological manifestations differential diagnosis |
| title | Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review |
| title_full | Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review |
| title_fullStr | Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review |
| title_full_unstemmed | Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review |
| title_short | Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review |
| title_sort | congenital bullous syphilis a case report from italy and a comprehensive literature review |
| topic | congenital bullous syphilis pemphigus syphiliticus secondary syphilis bullous lesions dermatological manifestations differential diagnosis |
| url | https://www.mdpi.com/1648-9144/61/1/158 |
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