Abstract / Summary
Congenital syphilis (CS) remains a preventable yet important cause of infant morbidity and mortality despite established antenatal screening and treatment programmes. Classical cutaneous manifestations such as syphilitic pemphigus are now infrequently encountered, often leading to diagnostic delays. A 4-month-old male infant presented with generalised vesiculobullous and papulosquamous skin lesions, poor weight gain and profuse mucoid nasal discharge. The lesions originated in the genital region and progressively involved the trunk, extremities, palms and soles. Examination revealed palmoplantar vesiculobullous lesions with desquamation, annular papulosquamous plaques and characteristic ‘snuffles’. Maternal records showed seroconversion for syphilis during late pregnancy. Infant serology demonstrated reactive venereal disease research laboratory and positive Treponema pallidum immunoglobulin M antibodies. Cerebrospinal fluid examination and skeletal survey were normal. The infant received intravenous ceftriaxone because penicillin was unavailable, with marked clinical improvement during follow-up. CS should be suspected in infants presenting with palmoplantar vesiculobullous lesions and snuffles. Early diagnosis, repeat maternal screening and timely treatment are essential for preventing adverse outcomes.