A Case of Late Congenital Syphilis

İngilizce (OpenAlex)

To the Editors Congenital syphilis results from the maternal-fetal transmission of Treponema pallidum, posing a life-threatening consequence of undiagnosed, untreated or inadequately treated maternal infection and can also lead to high morbidity rates.1 Following a dental examination revealing hypoplasia in his molar teeth, a 12-year-old male patient was referred to our clinic. His medical history was unremarkable, with no additional systemic complaints. On physical examination, his tooth structure appeared smaller than normal, with a deep notch in the middle of the cutting surfaces and tapered sides toward the biting edges. Poor development was observed in the first molar teeth (Fig. 1). Neurologic examination was normal. There were no skin findings. Laboratory tests revealed a hemoglobin level of 13.9 g/dL, platelet count of 296,000/mm3 and leukocyte count of 6500/mm3. Kidney and liver function tests were normal. Venereal disease research laboratory (VDRL) test was not reactive. Treponema pallidum particle agglutination assay (TPHA) was negative, while fluorescent treponemal antibody absorption (FTA-ABS) IgG was positive. Eye examination and hearing test were normal. The bone survey examination revealed normal bone structure integrity. A sclerotic limited, lobulated bone lesion consistent with a nonossifying benign fibroma was observed in the proximal diaphysis of the right humerus. The patient was diagnosed with late congenital syphilis and initiated penicillin G treatment (50,000 units/kg/dose once weekly for 3 weeks).FIGURE 1.: Tooth structure that is smaller than normal and has deep notches on the cutting surfaces (Hutchinson’s teeth), developmental disorder of first molar teeth (Moon’s molars).Late congenital syphilis, defined by clinical symptoms appearing after the age of 2, develops in approximately 40% of neonates born to women with untreated syphilis during pregnancy.1 Late manifestations of congenital syphilis arise due to scarring or persistent inflammation resulting from early systemic disease. Although tooth, bone, eye and eighth cranial nerve involvement, as well as gommatous lesions in visceral organs, skin or mucosa, are anticipated in most cases, it can also present with milder findings, as seen in our case.2 Congenital syphilis presents 3 main dental abnormalities; Hutchinson’s incisors, Moon’s molars (bud molars) and Fournier’s molars (mulberry molars).3 In congenital syphilis, affected incisors show a deep vertical notch in the middle of their free edge due to crown lobe fracture. This notch, alongside the narrowness and shortness of the tooth, is the main feature of Hutchinson’s teeth, the most recognized dental manifestation of the condition. Moon’s molars are small and dome-shaped. With this finding, the patient was referred to us. Fournier’s molars are a form of permanent molar defect associated with congenital syphilis in which there is a deep groove around the base of each ridge caused by enamel hypoplasia. Early treatment of either the mother during pregnancy or the neonate during the first 3 months of life can prevent most symptoms of late congenital syphilis.1 In recent years, an increase in adult syphilis cases and congenital syphilis cases has been noted.4 This trend may lead to an increase in late-diagnosed congenital syphilis cases in the future, which is concerning. Raising awareness about congenital syphilis is crucial in preventing the disease and improving outcomes through strict adherence to screening examinations, early diagnosis, and treatment.