Early congenital syphilis: experience with 13 consecutive cases seen at the University Hospital, Kuala Lumpur

While it is not difficult to recognise the classical clinical features of congenital syphilis in most cases, some of them may present with unusual manifestations which can defy early diagnosis. We report our experience with 13 cases of early congenital syphilis over a period of 10 years from 1980 to 1989. Twelve of the thirteen patients were less than 3 months at presentation. There were two infants born prematurely and six of the babies were born with a low birthweight (less than 2.5 kg). All but four patients survived following treatment. Skin lesions either in the form of typical vesiculobullous eruption over the palms and soles or a maculopapular skin rash over the body were the most common presentation and was seen in 10 patients. Splenomegaly with or without hepatomegaly was the most consistent physical sign. Radiological changes in the form of periostitis and/or metaphysitis were seen in all cases where an X-ray of the long bones was performed. An elevated serum immunoglobulin M, though non-specific for the disease, was found to be a useful screening test for recent infection.