Annular and Psoriasiform Secondary Syphilis in a Nine-Year-Old Girl Child: A Case Report

Syphilis, a sexually transmitted infection, may pose a challenge to diagnosis if it presents in an unusual form and in rare areas of the body. Non-typical lesions such as annular, maligna, nodular, nodular-ulcerative, corymbiform, leukoderma, pustular, berry-like, and chancriform presentations comprise about 29.6% of the skin manifestations of secondary syphilis. Although typical secondary syphilis is usually not associated with pruritus, 42% of secondary syphilis patients experience itching. A less frequently seen subtype of secondary syphilis is annular secondary syphilis. Its prevalence is approximately 5.7-13.6%. It occurs more commonly in children and people with dark skin. The location is mainly on the cheeks, frequently near the angle of the mouth. In rare cases, it can occur over the penis, feet, and legs. Syphilis in children is a very rare condition as children are seldom sexually active. Infection can occur through either close contact such as kissing, breastfeeding, vertical transmission, or secondary to abuse. We report a rare case of secondary syphilis having psoriasiform as well as annular lesions manifesting mainly on the palms and soles along with generalized lymphadenopathy in a nine-year-old girl. No evidence of hepatosplenomegaly, icterus, or anemia was seen clinically as well as on sonography. Treponema pallidum hemagglutination test was strongly positive. Venereal disease research laboratory test showed a titer of 1:128. Hepatitis B and HIV surface antigen tests were negative. Based on clinical and serological findings, the patient was diagnosed with secondary syphilis, having annular as well as psoriasiform lesions. The patient received tablets of azithromycin 250 mg on the first day. Because of gastritis, the patient was shifted to doxycycline 50 mg twice a day for 14 days. The skin lesions subsided completely after 10 days.