Case 1 A boy was delivered at 35 weeks' gestation by standard vaginal delivery. His mother was a 24-year-old gravida 4, para 1 woman. Purple erythematous macules and diffuse vesicular eruptions of various sizes were found extensively over the skin. The rapid plasma reagin (RPR) titer test of the newborn showed 1:16 positive and 1:32 weakly positive. There was no obvious history of maternal or paternal syphilitic infection; however, the mother confessed to having sexual contact with other men, and had a history of extrauterine pregnancy and spontaneous abortion. She showed 1:8 positive and 1 :16 weakly positive RPR titer test. The father's RPR titer was 1:8 positive and Treponema pallidum hemagglutination (TPHA) test was 1:160 positive. Physical examination revealed that this 2300-g boy had a rapid respiration of 55/min. The Apgar score was eight at 1 min. The boy's temperature was 36 degreesC. He had a normal skull, and the size of the bregma was 1.2 cm x 1.2 cm. The intranasal septum was normal with excessive excretions in the nostrils. The lips were slightly red. His intraoral mucous membrane was smooth, and his pharynx and throat were normal. His respiratory movement was symmetrical. He had sinus rhythm (135 b.p.m.) and no signs of abnormality. His breathing sound was clear with signs of effusion. The abdominal examination revealed hepatosplenomegaly. There was no transudate from the umbilicus. The liver was palpable 2cm below the costal margin. The spleen was also palpable just below the costal margin. The movement of the boy's limbs was normal. The fingernails had developed to the end of the fingers. The pleat drape of the metatarsal was less than one-third of the foot area. The boy had normal neural reflexes including rooting, sucking, and Moro reflex. Examination of the skin revealed a light purple color all over the body, with diffuse reddish-copper maculopapules, over which there were pale vesicles about 0.5-1.2 cm in size. Part of the vesicular eruption that occurred especially on the palms and soles had ruptured (Figs 1-6). The majority of the body surface was involved, but mucosal involvement was not noted. Laboratory examination revealed the following values: leukocyte count, 25.9 x 10(9)/L, containing 72% neutrophils and 23% lymphocytes; red blood cell count, 4.62 x 10(12)/L; hemoglobin, 173 g/L; and platelets, 117 x 10(9)/L. The urine test, excretion test, and blood chemistries were normal. The culture of the vesicular fluid was negative with no bacterial growth. Roentgenography was normal. The RPR titer test showed 1:6 positive and 1:32 weakly positive. Two weeks later, re-examination of blood routine tests showed: white blood cell count, 13.3 x 10(9)/L, containing 40% neutrophils and 60% lymphocytes; red blood cell count, 4.08 x 10(12)L; hemoglobin, 141 g/L; and platelets, 227 x 10(9)/L. According to the history, clinical manifestations, and RPR titer test, the following diagnosis was made: early congenital syphilis, premature and low weight infant. The boy was treated with procaine penicillin intravenously at 100,000 U/kg/day for 15 days. The eruption subsided in 2 weeks. The infant was carefully followed up without recurrence of eruption, and serologic RPR tests were performed at 1, 2, and 3 months after the conclusion of treatment. The RPR titer was 1:4 positive at the third month. Case 2 A 2-month-old girl presented with an acute onset of a shin eruption accompanied by fever, cough, and dyspnea. The girl had no abnormal appearances at full-term delivery. The girl developed an erythematous macular and papular eruption on her palms and soles 12 days afterwards. She had been diagnosed and treated for "dermatitis" at another hospital, but the treatment was not effective. The eruption persisted and spread to the trunk and limbs. On the 21st day, the girl developed a cough, snuffles, dyspnea, and fever. Physical examination revealed a restless infant with a temperature of 39 inverted perpendicularC. Moist rales were audible on chest auscultation. Abdominal examination revealed hepatosplenomegaly and the existence of borborygmus. The liver was palpable 5cm below the costal margin and 6 cm below the xiphoid. The spleen was palpable 3 cm below the costal margin. There were symmetrical reddish-brown macules and papules on the buttocks, palms, and soles (Figs 7-9), some with scaling and pigmentation. In some parts, the eruption had ruptured and left a denuded area that developed extensive maceration, ulceration, and crusting. The perioral and periorbital areas were eroded with excretions. Laboratory studies revealed the following values: serologic RPR titer, 1:128 positive; TPHA titer, 1:160 positive; 19s-lgM test positive. Both the RPR and TPHA tests of the parents were positive. Procaine penicillin was given intramuscularly at 100,000 U/kg/day for 10 days. The infant recovered quickly and the eruption cleared within 2 weeks. The infant was followed up carefully acid RPR test results were negative 1, 2, and 3 months after treatment.
