Early Congenital Syphilis Presenting With Severe Congenital Pneumonia and Cutaneous Manifestations in a Neonate at Birth: A Case Report

Transplacental transmission of <i>Treponema pallidum</i> spirochetes from an infected mother to the fetus during pregnancy results in the infectious condition known as congenital syphilis (CS). Once a forgotten disease, CS has now re-emerged. We report the clinical case of an early CS in a neonate girl presented with severe congenital pneumonia (pneumonia alba) requiring intubation, along with skin lesions that were visible from birth on the palms and soles of the feet. Neonate's treponemal and non-treponemal tests were positive, and the mother's rapid plasma reagin (RPR) test was also positive after birth, and the mother did not have prenatal screening or follow-ups due to socioeconomic reasons. Neonate's radiological investigations found a diffuse, uniform opacification of both lungs ("white lung") on chest X-ray, consistent with congenital pneumonia (pneumonia alba), in addition to increased radiolucency, widening, irregularity, and erosions in the lower limbs, with periventricular leukomalacia and possible petechial hemorrhages on cerebral magnetic resonance imaging. The neonate was given a 10-day course of intravenous penicillin G along with five days of concurrent inotrope support, IV hydrocortisone for seven days, IV vancomycin and meropenem for 10 days, along with respiratory support. The neonate stayed in the neonatal intensive care unit (NICU) for a period of 54 days in total and was discharged with a clinically favorable outcome.