Abstract：
UNASSIGNED: Although a rare disease, the incidence of congenital syphilis is on the rise in the US. We report a case of early congenital syphilis in a 1-day-old premature boy with positive Rapid plasma reagin titer, respiratory insufficiency, disseminated intravascular coagulation, and encephalopathy, born to a mother with known syphilis infection. Skin examination showed diffuse truncal petechiae, desquamation of the distal extremities, and violaceous, retiform plaques on the buttocks and lower extremities. A biopsy was performed to rule out an infectious etiology or vasculitis. Histopathologic examination revealed irregular epidermal acanthosis with orthokeratosis and parakeratosis. There were foci of neutrophilic infiltrate forming rare pustules within the stratum corneum and focal intraepidermal eosinophils, neutrophils, and rare dyskeratotic keratinocytes. In the dermis, there was some minimal endothelial swelling with a perivascular, interstitial, and periadnexal infiltrate of lymphocytes, eosinophils, and rare plasma cells. A Treponema pallidum immunostain highlighted spirochetes present within the epidermis and within the eccrine ducts. Penicillin G therapy was administered for 10 days. The infant\'s Rapid plasma reagin titer trended downward until it was negative 6 months after birth. Literature review reveals 8 case reports within the last 20 years describing the histopathology of rashes in congenital syphilis. Herein we summarize the reported histopathology of rashes in congenital syphilis and compare it to the histopathology of rashes in secondary syphilis in adults.
摘要：
未经证实：虽然是一种罕见的疾病，在美国，先天性梅毒的发病率呈上升趋势。我们报告了一例1天大的早产男孩的早期先天性梅毒，其快速血浆反应素滴度呈阳性，呼吸功能不全,弥散性血管内凝血,和脑病，出生于已知感染梅毒的母亲。皮肤检查显示弥漫性躯干瘀斑，远端脱皮，和暴力,在臀部和下肢形成斑块。进行活检以排除感染性病因或血管炎。组织病理学检查显示不规则的表皮棘皮病，并伴有角膜角化和角化不全。有嗜中性粒细胞浸润灶在角质层和局灶性表皮内嗜酸性粒细胞内形成罕见脓疱，中性粒细胞，和罕见的角质形成细胞。在真皮中，血管周围有轻微的内皮肿胀，间质,和淋巴细胞周围浸润，嗜酸性粒细胞,和罕见的浆细胞。梅毒螺旋体免疫染色突出了表皮和外分泌管内存在的螺旋体。青霉素G治疗10天。婴儿的快速血浆反应素滴度呈下降趋势，直到出生后6个月为阴性。文献回顾显示，过去20年中有8例病例报告描述了先天性梅毒皮疹的组织病理学。本文总结了已报道的先天性梅毒皮疹的组织病理学，并将其与成人继发性梅毒皮疹的组织病理学进行了比较。
