Case report http://dx.doi.org/10.3345/kjp.2011.54.12.512 Korean J Pediatr 2011;54(12):512-514 Early congenital syphilis presenting with skin eruption alone: a case report Hak Young Kim, MD1, Beom Joon Kim, MD, PhD2, Ji Hyun Kim, MD, PhD3,4, Byoung Hoon Yoo, MD, PhD1 1Departments of Pediatrics and 2Dermatology, Chung- Ang University College of Medicine, 3Department of Pediatrics and 4Environmental Health Center for Atopic Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Received: 25 March 2011, Revised: 7 June 2011 Accepted: 16 July 2011 Corresponding author: Ji Hyun Kim, MD, PhD Department of Pediatrics, Samsung Medical Center, Sung- kyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-1035, Fax: +82-2-3410-0805 E-mail: narimy@hanmail.net Congenital syphilis is one of the most well-known congenital infections, yet it remains a worldwide public health problem. Congenital syphilis can involve any organ system and present with various symptoms. However, early diagnosis of congenital syphilis is difficult because more than half of the affected infants are asymptomatic, and the signs in symptomatic infants may be subtle and nonspecific. Here, we report a case of congenital syphilis with only a skin rash, which led to a delay in diagnosis. This case indicates that congenital syphilis should be con- sidered throughout early childhood. Key words: Congenital syphilis, Skin rash Copyright © 2011 by The Korean Pediatric Society This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Congenital syphilis, caused byTreponema pallidum is still a public health issue worldwide, especially in developing countries1). Accor- dingly, it is important to be familiar with its symptoms, which can be subtle and nonspecific2). Recently, an increase in the incidence and prevalence of early congenital syphilis was observed in Korea as well as other Western countries despite prenatal serologic screening and treatment programs which are included in the routine antenatal examination1,3). Therefore, physicians should be aware of the diverse clinical features of syphilis to enable early diagnosis of the disease. We report here a case of congenital syphilis in a 3-month-old infant who had whole body skin eruption and no other specific symptoms, which led to a delay in diagnosis. His mother was tested for the disease during the prenatal period and the test was negative; however, she tested positive for syphilis later. Case report A 3-month-old boy was admitted due to a 3-week history of an asymptomatic, widespread skin eruption. He was given the Diphtheria-Tetanus-acellular Pertussis (DTaP) vaccination 2 days prior to skin rash and his parents had taken him to several pediatric and dermatologic clinics, but could not identify his illness. He had been born to a 24-year-old, G1P1A0 mother who had adequate prenatal care at other clinics. She was tested for syphilis at 12 and 38 weeks of gestational age and was told that the tests were negative. The patient was delivered at 39+6 weeks of gestational age by normal 512