LITERATURE REVIEW OF FLAT CONDYLOMA IN CHILDREN AND A CASE REPORT OF UNCOMMON PRESENTATION MIMICKING BUSCHKE-LÖWENSTEIN TUMOR

Introduction Syphilis is a predominantly sexually transmitted infection with increasing detection rates and a wide range of clinical manifestations. In children, acquired syphilis presents almost all the features seen in adults, and in the perianal region, a vegetating lesion, known as flat condyloma, may occur. This cutaneous manifestation is sometimes the only expression of secondary syphilis and may mimic other pathologies. A high index of suspicion is important due to its primary mode of transmission, sexual contact, especially in the context of childhood cases where sexual abuse should be considered as a hypothesis.

Objective To identify cases of flat condyloma in children as a manifestation of secondary syphilis in the scientific literature and report an unusual presentation of this lesion mimicking Buschke-Löwenstein tumor.

Method A literature review through a search in the PUBMED database in June 2024, using the descriptors “flat condyloma” and “child,” along with the presentation of a case report.

Results Eight publications from 1989 to 2024 were found, showing flat condyloma as the most common manifestation of secondary syphilis in children and the involvement of medico-legal issues in the context of child sexual abuse. The case to be presented and compared involves a 5-year-old male patient with a pruritic, white, vegetating perianal lesion for 3 months. There was a history of similar lesions in his 9-year-old sister, 8-year-old cousin, and his mother (pregnant). The hypothesis of Buschke-Löwenstein tumor was raised, and a proctological examination under anesthesia revealed an extensive, irregular, circumferential, elevated lesion, measuring 10 cm in diameter on the perianal skin and circumferential involvement of the anal canal upon rectal examination. Histopathological study suggested a secondary non-granulomatous lesion due to syphilis with a dense plasmocytic infiltrate in the dermis, and immunohistochemistry was negative for human papillomavirus. After treatment with crystalline penicillin, the patient progressed with a hyperchromic scar lesion and was discharged with follow-up in coloproctology and pediatrics focused on child sexual abuse.

Conclusion The differential and accurate diagnosis of pediatric syphilis, in the face of an uncommon manifestation mimicking another pathology, is crucial for the treatment of the infection, prevention of morbidity, and identification of cases of child sexual abuse, prompting necessary medico-legal actions.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025